Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like J*

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
28	Fee-for-Service	1750841227	1750841227	1	1	JIMENEZ, GUILLERMO MD	5/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188168	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
41	Fee-for-Service	1326278490	1326278490	1	12	JANESRI DE SILVA M.D. A PROF	10/11/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ORP	240 S. LA CIENEGA BLVD	350	BEVERLY HILLS	CA	90211	3324	19	06037	34.06392928	-118.3761548	Los Angeles County
109	Fee-for-Service	1396732210	1396732210	1	1	JOHNSON, CALVIN MD	5/1/2000	207L00000X	NA	Other	026	PHYSICIANS	83619	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
160	Fee-for-Service	1447319165	1447319165	1	1	JETTON, JANICE I NP	5/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18081 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	1304	30	06059	33.69987737	-117.9892394	Orange County
228	Fee-for-Service	1497814594	1497814594	3	1	JAFA PHARMACEUTICALS INC	8/8/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	95 MONTGOMERY DR	SUITE 108	SANTA ROSA	CA	95404	6617	49	06097	38.442357	-122.704641	Sonoma County
283	Fee-for-Service	1922531250	1922531250	1	1	JIMENEZ, KRYSTAL A MD	7/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159831	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
286	Fee-for-Service	1073991915	1073991915	1	1	JACK EDWARD STEPHENS	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
351	Fee-for-Service	1053498311	1053498311	1	1	JACK, MEG E MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
397	Fee-for-Service	1770579583	1770579583	1	1	JOHN M. RUSSO	8/30/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
457	Fee-for-Service	1811378425	1811378425	1	1	JIRAMONGKOLCHAI, PAWINA MD	7/3/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	179323	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
462	Fee-for-Service	1689800468	1689800468	1	1	JIANG, LEI MD	10/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127462	18	Ophthalmology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
493	Fee-for-Service	1427673623	1427673623	1	1	JOSE, ETHAN MD	10/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
541	Fee-for-Service	1407968498	1407968498	2	1	JAMES' MERCY SOUTHWEST PHARM	8/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ACY	500 OLD RIVER RD	SUITE 125	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
545	Fee-for-Service	1689628752	1689628752	1	1	JAVARI, NATHAN A DPM	2/15/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	231 W VERNON AVE	STE 109	LOS ANGELES	CA	90037	2778	19	06037	34.0038305	-118.2774195	Los Angeles County
652	Fee-for-Service	1386085009	1386085009	1	2	JASMINE L. RAMOS M.D., PC	1/22/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	73555 SAN GORGONIO WAY	None	PALM DESERT	CA	92260	3549	33	06065	33.7231981	-116.3812055	Riverside County
665	Fee-for-Service	1821199845	1821199845	1	1	JONES, SHARON J MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70338	41	Internal Medicine	0	In state provider	None	644 SOUTHLAND MALL RD	None	HAYWARD	CA	94545	2150	01	06001	37.65079738	-122.0986732	Alameda County
1103	Fee-for-Service	1811658495	1811658495	1	1	JUNG, ANDREW LMFT	1/11/2024	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
1123	Fee-for-Service	1417962291	1417962291	1	1	JOTHIKUMAR, T MD	5/13/1998	174400000X	NA	Other	026	PHYSICIANS	31143	01	General Practice	0	In state provider	None	82820 TRONA RD	None	TRONA	CA	93562	1929	36	06071	35.75769665	-117.3778648	San Bernardino County
1124	Fee-for-Service	1730771734	1730771734	1	1	JANE M JOHNSON	6/15/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	9300 W STOCKTON BLVD	200	ELK GROVE	CA	95758	8070	34	06067	38.419101	-121.3945425	Sacramento County
1189	Fee-for-Service	1477134070	1477134070	1	1	JOY, ROSE MD	10/17/2024	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
1344	Fee-for-Service	1689643843	1689643843	1	1	JO ANN GATES MD	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 PORTSMOUTH AVE	None	STRATHAM	NH	03885	2585	00	None	42.99131168	-70.92807101	Rockingham County
1347	Fee-for-Service	1285044982	1285044982	1	1	JAWED, MOHSIN MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145164	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
1468	Fee-for-Service	1588691489	1588691489	1	1	JAIN, ARUN MD	12/1/2020	207P00000X	NA	Other	026	PHYSICIANS	168860	None	None	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
1593	Fee-for-Service	1013959915	1013959915	1	1	JAMES, LINDA K MD	9/7/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84834	02	General Surgery	0	In state provider	None	721 RIVER DR	STE B	FORT BRAGG	CA	95437	5402	23	06045	39.43204627	-123.801581	Mendocino County
1600	Fee-for-Service	1174852230	1174852230	1	1	JUAREZ VARGAS, LUIS A MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123394	01	General Practice	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
1639	Fee-for-Service	1225657695	1225657695	1	1	JENG-JONG LIAO MD INC	4/20/2020	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 N GARFIELD AVE	SUITE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
1672	Fee-for-Service	1548039126	1548039126	1	1	JANVI RX INC	2/14/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	34151 DATE PALM DR	G	CATHEDRAL CITY	CA	92234	6831	33	06065	33.801111	-116.458167	Riverside County
1877	Fee-for-Service	1124515119	1124515119	1	5	JEFFREY BROOKS MD INC	7/18/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1261 TRAVIS BLVD	STE 150	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
2048	Fee-for-Service	1114430105	1114430105	1	1	JETTON, JOHANNA CNM	7/25/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
2152	Fee-for-Service	1558396655	1558396655	1	1	JUNEJA, MANISH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
2247	Fee-for-Service	1205807229	1205807229	1	1	JUAREZ, PATRICIA P MD	7/31/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55860	01	General Practice	0	In state provider	None	752 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6658	37	06073	32.61800405	-117.0232585	San Diego County
2252	Fee-for-Service	1841303948	1841303948	1	1	JANG, MICHELE S	5/6/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1422 MONTEREY ST	STE C102	SAN LUIS OBISPO	CA	93401	2944	40	06079	35.28569426	-120.6552663	San Luis Obispo County
2305	Fee-for-Service	1487802898	1487802898	1	1	JOHAL, DHARAMPAL S MD	9/23/2003	207R00000X	NA	Other	026	PHYSICIANS	56018	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
2395	Fee-for-Service	1124030010	1124030010	1	1	JANKIEWICZ, JOSEPH J MD	4/30/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	45521	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
2415	Fee-for-Service	1962451534	1962451534	1	1	JOGLEKAR,RAJIV	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ARMED HEALTH	800 NORTH FANT ST	None	ANDERSON	SC	29621	5708	00	None	34.51140542	-82.64743236	Anderson County
2540	Fee-for-Service	1063642866	1063642866	1	1	JUERGEN P KRAUTHAMMER MD INC	6/1/2009	208600000X	NA	General Surgery	026	PHYSICIANS	31682	01	General Practice	0	In state provider	None	6057 N FIRST STREET	STE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
2542	Fee-for-Service	1851719678	1851719678	1	1	JAMES, TRAM H NP	9/19/2014	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
2563	Fee-for-Service	1710419080	1710419080	1	1	JONES, TYLER B MD	8/3/2021	207L00000X	NA	Other	026	PHYSICIANS	173601	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
2593	Fee-for-Service	1487802898	1487802898	1	1	JOHAL, DHARAMPAL S MD	9/23/2003	207R00000X	NA	Other	026	PHYSICIANS	56018	41	Internal Medicine	0	In state provider	INC	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
2646	Fee-for-Service	1346334935	1346334935	1	1	JOHNSON, ERIC O MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	55858	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
2687	Fee-for-Service	1346255759	1346255759	1	1	JAMBHEKAR, KEDAR 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
2821	Fee-for-Service	1053975508	1053975508	1	1	JARAMILLO, ERICKA MD	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177992	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
2829	Fee-for-Service	1063642866	1063642866	1	1	JUERGEN P KRAUTHAMMER MD INC	6/1/2009	208600000X	NA	General Surgery	026	PHYSICIANS	31682	02	General Surgery	0	In state provider	None	6057 N FIRST STREET	STE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
2959	Fee-for-Service	1730312851	1730312851	1	1	JULIAN, JASON	1/22/2013	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
3073	Fee-for-Service	1518191717	1518191717	1	1	JOHNSTON, TAHNEY C PSYD	1/27/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
3104	Fee-for-Service	1841480936	1841480936	1	1	JAYASINGHE-COORAY, AMALI	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82882	41	Internal Medicine	0	In state provider	S MD	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
3126	Fee-for-Service	1467457093	1467457093	1	1	JULIAN, JOHN C MD	8/24/2004	208800000X	NA	Other	026	PHYSICIANS	75874	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
3171	Fee-for-Service	1114045945	1114045945	1	1	JAMESON, JULIANNE D PSY	12/18/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 TERRADO PLAZA	STE 104	COVINA	CA	91723	3419	19	06037	34.07598226	-117.8892839	Los Angeles County
3210	Fee-for-Service	1275621443	1275621443	1	1	JONAS, WAYNE BABCOCK MD	3/31/1984	207P00000X	NA	Other	026	PHYSICIANS	53806	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY SERV MED GRP	#1 COLBY AT WEBSTER	None	BERKELEY	CA	94705	0000	01	06001	37.855449	-122.257809	Alameda County
3276	Fee-for-Service	1114117454	1114117454	1	1	JAZAYERI, REZA MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108833	20	Orthopedic Surgery	0	In state provider	None	2601 E MAIN ST	STE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
3319	Fee-for-Service	1023492352	1023492352	1	1	JOHNSON, SEAN LCSW	5/31/2019	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
3323	Fee-for-Service	1710244462	1710244462	1	1	JALALI, FARID MD	8/21/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	129339	10	Gastroenterology (M.D. only)	0	In state provider	None	3833 WORSHAM AVENUE	SUITE 300	LONG BEACH	CA	90808	1745	19	06037	33.828552	-118.1462755	Los Angeles County
3362	Fee-for-Service	1427290154	1427290154	1	1	JONES, CANDACE J MD	8/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105563	40	Pediatrics	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
3374	Fee-for-Service	1861037954	1861037954	1	1	JURUPA UNIFIED SCHOOL DIST	12/18/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	3924 RIVERVIEW DR	None	JURUPA VALLEY	CA	92509	0000	33	06065	33.99857971	-117.4142203	Riverside County
3458	Fee-for-Service	1982674743	1982674743	1	1	JONATHAN C WEINRACH M.D.	7/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10229 N 92ND ST	STE 102	SCOTTSDALE	AZ	85258	4562	00	None	33.579099	-111.878703	Maricopa County
3542	Fee-for-Service	1760477467	1760477467	1	2	JEWISH FAMILY SERVICE OF	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	285 N EL CAMINO REAL	STE 218	ENCINITAS	CA	92024	5385	37	06073	33.05317488	-117.2611779	San Diego County
3712	Fee-for-Service	1679187264	1679187264	1	1	JACINTO, MATTHEW D CNP	10/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7130 N SHARON AVE	STE 100	FRESNO	CA	93720	3386	10	06019	36.83983419	-119.7592871	Fresno County
3808	Fee-for-Service	1225273808	1225273808	1	1	JOHNSON, LINCY	9/16/2013	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
3915	Fee-for-Service	1831387877	1831387877	1	1	JENSEN, LARS	7/1/1994	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	190 N WIGET LN	STE 109	WALNUT CREEK	CA	94598	2417	07	06013	37.92628945	-122.0245576	Contra Costa County
3940	Fee-for-Service	1689106122	1689106122	1	1	JEON, DEBORAH B MD	6/13/2021	207L00000X	NA	Other	026	PHYSICIANS	156894	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4142	Fee-for-Service	1194968339	1194968339	1	1	JOHNSON, DUSTIN K MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129671	30	Radiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
4204	Fee-for-Service	1013959642	1013959642	1	1	JEFFREY B GLASER MD MEDICAL	1/6/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	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
4254	Fee-for-Service	1689160780	1689160780	1	1	JOYCE, NAOMI A LMFT	3/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E CARNEGIE DR	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
4255	Fee-for-Service	1366437402	1366437402	1	1	JONES, TIMOTHY H MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55265	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 ALAMO PINTADO RD	None	SOLVANG	CA	93463	2220	42	06083	34.60203	-120.1262085	Santa Barbara County
4270	Fee-for-Service	1336721422	1336721422	1	1	JELEN, MITCHELL F OD	10/30/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	620 W YOSEMITE AVE	None	MADERA	CA	93637	4523	20	06039	36.95712331	-120.0665526	Madera County
4315	Fee-for-Service	1982170841	1982170841	1	1	JACLYNNE MAGNO-CHOI	12/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NC	13310 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	4016	19	06037	33.94178249	-118.049787	Los Angeles County
4397	Fee-for-Service	1558325126	1558325126	1	1	JAMES S CERNEKA	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	0000	00	None	33.29768043	-111.8761089	Maricopa County
4544	Fee-for-Service	1366437402	1366437402	1	1	JONES, TIMOTHY H MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55265	08	Family Practice	0	In state provider	None	700 ALAMO PINTADO RD	None	SOLVANG	CA	93463	2220	42	06083	34.60203	-120.1262085	Santa Barbara County
4570	Fee-for-Service	1396927257	1396927257	1	1	JULIO C LUPPINO	7/16/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9017 RESEDA BLVD	SUITE 103	NORTHRIDGE	CA	91324	3970	19	06037	34.234155	-118.5360975	Los Angeles County
4592	Fee-for-Service	1144917162	1144917162	1	1	JAMES BAILEY MD INC	11/1/2023	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2936 DE LA VINA ST	None	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
4610	Fee-for-Service	1548467483	1548467483	1	1	JOHNSON, MICHAEL W	6/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
4804	Fee-for-Service	1629171558	1629171558	1	1	JOHNSON, KAREN J MD	12/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55431	40	Pediatrics	0	In state provider	None	2320 BATH ST	STE 107	SANTA BARBARA	CA	93105	4376	42	06083	34.43082689	-119.7223032	Santa Barbara County
4871	Fee-for-Service	1568664852	1568664852	1	1	JARED PETER AUSTIN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
4903	Fee-for-Service	1578825303	1578825303	1	1	JORDAN-LLOYD, DIANA P LMFT	9/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA	STE 155	RANCHO CUCAMONGA	CA	91730	3879	36	06071	34.10227306	-117.5715643	San Bernardino County
4921	Fee-for-Service	1669589644	1669589644	1	1	JEYARANJAN, T MD	6/20/1978	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32442	40	Pediatrics	0	In state provider	None	284 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	1733	19	06037	34.03245974	-118.1532499	Los Angeles County
4933	Fee-for-Service	1255314399	1255314399	1	1	JOHL, HERSHAN MD	7/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70482	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
4975	Fee-for-Service	1669019683	1669019683	1	1	JUSTIN ROGERS	10/13/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
4999	Fee-for-Service	1386750560	1386750560	1	1	JERN, CHERYL L LCSW	12/27/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7 4TH ST	11	PETALUMA	CA	94952	3072	49	06097	38.23300765	-122.640298	Sonoma County
5036	Fee-for-Service	1639520273	1639520273	1	1	JOHNSON, ALICE V NP	2/19/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
5106	Fee-for-Service	1205465051	1205465051	1	1	JORDAN, MONICA MD	10/4/2023	208M00000X	NA	Other	026	PHYSICIANS	185216	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
5184	Fee-for-Service	1275775207	1275775207	1	1	JHA, PRIYANKA MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118551	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
5253	Fee-for-Service	1497302954	1497302954	1	1	JONES, EVAN W LMFT	7/16/2024	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
5258	Fee-for-Service	1316042583	1316042583	1	1	JOHNSON, SIDNEY M. MD	2/20/2013	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
5426	Fee-for-Service	1124168711	1124168711	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	840 E PIONEER AVE	None	REDLANDS	CA	92374	1802	36	06071	34.08087155	-117.172368	San Bernardino County
5449	Fee-for-Service	1780836676	1780836676	1	1	JC MAX INC	1/20/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ABC PHARMACY	826 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	36	06071	34.1068263	-117.3547603	San Bernardino County
5498	Fee-for-Service	1629276191	1629276191	2	1	JOE CHAN	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
5625	Fee-for-Service	1487702296	1487702296	1	1	JORDAN, JONI T MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58405	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
5639	Fee-for-Service	1174670327	1174670327	1	1	JAMES, ROSILDA PHD	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
5674	Fee-for-Service	1518124809	1518124809	1	1	JOHNSON, APRIL V	5/12/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
5678	Fee-for-Service	1063807543	1063807543	2	1	JONES, BRIANNA DO	3/17/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19078	08	Family Practice	0	In state provider	None	200 WELLS RD	100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
5701	Fee-for-Service	1811277916	1811277916	1	1	JOO, SU JIN MD	9/19/2022	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	181978	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
5710	Fee-for-Service	1255355483	1255355483	1	1	JORDAN, RICHARD T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56253	41	Internal Medicine	0	In state provider	None	873 RALSTON AVE	None	BELMONT	CA	94002	2205	41	06081	37.51993076	-122.2764698	San Mateo County
5796	Fee-for-Service	1073986642	1073986642	1	1	JEVONS, CHARLOTTE E PHD	1/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
5831	Fee-for-Service	1912908732	1912908732	1	1	JESSICA BERKOWITZ, 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	255 LAFAYETTE AVE	None	SUFFERN	NY	10901	4812	00	None	41.111613	-74.135043	Rockland County
5884	Fee-for-Service	1831756444	1831756444	1	1	JAIN, LAKSHAY MD	10/29/2024	207R00000X	NA	Other	026	PHYSICIANS	177039	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
5904	Fee-for-Service	1437681301	1437681301	1	1	JACKSON, RANDY MD	8/17/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169485	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
5933	Fee-for-Service	1871954388	1871954388	1	1	JOHN F KENNEDY UNIVERSITY	6/10/2016	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
5934	Fee-for-Service	1457500936	1457500936	1	1	JEFFREY LEA HARDIN, 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	2675 W TAYLORSVILLE BLVD	None	TAYLORSVILLE	UT	84129	2208	00	None	40.65438556	-111.9571398	Salt Lake County
5939	Fee-for-Service	1194047126	1194047126	1	1	JUDGE, LUKE M MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111085	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
5970	Fee-for-Service	1649480088	1649480088	1	1	JENSEN, BRETT 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	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
5979	Fee-for-Service	1033203740	1033203740	1	1	JOSHI, MADHUP MD	10/17/2023	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	55251	None	None	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
6019	Fee-for-Service	1841312972	1841312972	1	1	JALALI, FARANGIS MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	91998	01	General Practice	0	In state provider	None	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	33	06065	33.78658073	-117.2226438	Riverside County
6032	Fee-for-Service	1518002427	1518002427	1	1	JOHNSTON, TIM F MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	2	Out of state provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
6115	Fee-for-Service	1487748059	1487748059	1	1	JOA DBA JOHNSON'S ORTHOP	7/1/1996	332BC3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7254 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3829	33	06065	33.94390763	-117.4049424	Riverside County
6184	Fee-for-Service	1689984239	1689984239	1	1	JOHNSON, KELLY L NP	5/17/2018	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
6215	Fee-for-Service	1811156524	1811156524	2	2	JENYMELS HOME CARE INC	4/23/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12108 HIBBING ST	None	ARTESIA	CA	90701	6832	19	06037	33.85728459	-118.074395	Los Angeles County
6221	Fee-for-Service	1871954388	1871954388	1	1	JOHN F KENNEDY UNIVERSITY	6/10/2016	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
6299	Fee-for-Service	1912981770	1912981770	1	1	JOHL, KARNJIT K MD	11/10/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61180	41	Internal Medicine	0	In state provider	None	4600 BROADWAY	SUITE 1100	SACRAMENTO	CA	95820	1527	34	06067	38.546127	-121.452669	Sacramento County
6315	Fee-for-Service	1518002427	1518002427	1	1	JOHNSTON, TIM F MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	2	Out of state provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
6321	Fee-for-Service	1871092957	1871092957	1	1	JOY OPENS DOORS SPEECH AND O	10/14/2021	261QM1300X	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
6364	Fee-for-Service	1508216581	1508216581	1	1	JESSE TWU	10/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
6379	Fee-for-Service	1679144562	1679144562	1	1	JOHNSON, JERALD CRNA	7/15/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
6404	Fee-for-Service	1487748059	1487748059	1	1	JOA DBA JOHNSON'S ORTHOP	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	7254 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3829	33	06065	33.94390763	-117.4049424	Riverside County
6409	Fee-for-Service	1144392895	1144392895	1	1	JOHNSON, SHAWNDA G MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71253	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
6485	Fee-for-Service	1245396456	1245396456	1	1	JANDA, PRITPAL OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
6508	Fee-for-Service	1871954388	1871954388	1	1	JOHN F KENNEDY UNIVERSITY	6/10/2016	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
6609	Fee-for-Service	1871092957	1871092957	1	1	JOY OPENS DOORS SPEECH AND O	10/14/2021	261QM1300X	NA	Other	037	SPEECH 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
6629	Fee-for-Service	1487781829	1487781829	1	1	JOHNSEN, HEGE MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	107535	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
6660	Fee-for-Service	1720079049	1720079049	1	1	JOHNSON, COLLEEN A MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81584	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
6669	Fee-for-Service	1477882280	1477882280	1	1	JOHNSON, ERIKA L PT	10/28/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11206 OLIVE DR	102	BAKERSFIELD	CA	93312	5846	15	06029	35.41981347	-119.1272175	Kern County
6719	Fee-for-Service	1003130105	1003130105	1	1	JAMAL, NASHEED I MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120340	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
6779	Fee-for-Service	1275047649	1275047649	1	1	JANKE, LEAH CCC-SP	3/8/2022	2355S0801X	NA	Other	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
6784	Fee-for-Service	1003054750	1003054750	1	1	JEON, BYUNG HO LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	327 S WESTERN AVE	None	LOS ANGELES	CA	90020	3804	19	06037	34.0681472	-118.3091427	Los Angeles County
6809	Fee-for-Service	1174655799	1174655799	1	1	JAMES, COLETTE D LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79089	-	NOT APPLICABLE	0	In state provider	None	15116 S GIBSON	None	LOS ANGELES	CA	90220	3106	19	06037	33.89561249	-118.1889466	Los Angeles
6880	Fee-for-Service	1659632867	1659632867	1	1	JARA, SEBASTIAN M MD	12/19/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	192050	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
6898	Fee-for-Service	1871092957	1871092957	1	1	JOY OPENS DOORS SPEECH AND O	10/14/2021	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	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
6954	Fee-for-Service	1295373389	1295373389	1	1	JANETS ENTERPRISE INC	5/12/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10324 RING AVE	None	RANCHO CUCAMONGA	CA	91737	4324	36	06071	34.13297093	-117.5800366	San Bernardino County
6989	Fee-for-Service	1083671424	1083671424	1	1	JONES, DAISY Y DO	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7375	40	Pediatrics	0	In state provider	None	2151 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75424753	-121.455621	San Joaquin County
7039	Fee-for-Service	1538190830	1538190830	1	1	JACKSON, ROBERT J MD INC	7/1/2002	207T00000X	NA	General Surgery	026	PHYSICIANS	71112	14	Neurological Surgery	0	In state provider	None	23961 CALLE DE LA MAGDAL	STE 504	LAGUNA HILLS	CA	92653	3665	30	06059	33.60999658	-117.7126577	Orange County
7055	Fee-for-Service	1760477467	1760477467	1	1	JEWISH FAMILY SERVICE OF	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8804 BALBOA AVE	None	SAN DIEGO	CA	92123	1506	37	06073	32.82059406	-117.1382382	San Diego County
7067	Fee-for-Service	1750398954	1750398954	1	1	JAWORSKY, JAMES S MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55263	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
7252	Fee-for-Service	1326454885	1326454885	1	1	JESSICA M. HOYLE	11/15/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	890 OAK ST SE	None	SALEM	OR	97301	3905	00	None	44.932887	-123.0341175	Marion County
7383	Fee-for-Service	1144200338	1144200338	1	1	JAN, FRANK K MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83568	25	Physical Medicine and Rehabilitation	0	In state provider	None	1529 SEABRIGHT AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.97862009	-122.0098896	Santa Cruz County
7451	Fee-for-Service	1043519382	1043519382	1	1	JENSEN, TREVOR P MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124409	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
7459	Fee-for-Service	1083862494	1083862494	1	1	JULIEN, GENEVIVE M PSYD	10/22/2020	225C00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
7491	Fee-for-Service	1780683789	1780683789	1	1	JAO, DIANA V MD	2/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68273	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
7532	Fee-for-Service	1679883581	1679883581	1	1	JENQ, LEELAN A	9/17/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18531 ROSCOE BLVD	STE 215A	NORTHRIDGE	CA	91324	5462	19	06037	34.22075552	-118.5373395	Los Angeles County
7559	Fee-for-Service	1487606026	1487606026	1	2	J PAUL WIESNER & ASSOCIATES	12/19/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	1	Border provider	DA	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
7598	Fee-for-Service	1700124765	1700124765	1	1	JOSHUA BUCHER	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
7631	Fee-for-Service	1982790960	1982790960	1	1	JANZEN, DANI S	5/10/2017	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
7658	Fee-for-Service	1427351337	1427351337	1	1	JADE, TURNER MD	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
7728	Fee-for-Service	1952490286	1952490286	1	1	JANET PHARMACY ENTERPRISES	9/1/2001	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5596 E LA PALMA AVE	None	ANAHEIM	CA	92807	2108	30	06059	33.85972043	-117.7931955	Orange County
7735	Fee-for-Service	1235328022	1235328022	1	1	JAVAHERI, AHSKAN MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98944	38	Geriatrics	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
7798	Fee-for-Service	1750787842	1750787842	1	1	JDCM CORPORATION	10/7/2016	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1749 S EUCLID AVE	STE A	ONTARIO	CA	91762	5832	36	06071	34.041501	-117.650133	San Bernardino County
7808	Fee-for-Service	1487263968	1487263968	1	1	J & E HOME INC	9/21/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	627 LARCHMONT DR	None	DALY CITY	CA	94015	3637	41	06081	37.68772807	-122.4836599	San Mateo County
7864	Fee-for-Service	1992980635	1992980635	1	1	JONES, SYLVIA R MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98445	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
7901	Fee-for-Service	1871682096	1871682096	1	1	JOSHI, C. R. MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	25562	41	Internal Medicine	0	In state provider	None	1350 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2898	56	06111	34.27163453	-118.7729325	Ventura County
7909	Fee-for-Service	1023118098	1023118098	1	1	JAMIL, SHAZIA M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
7954	Fee-for-Service	1962588491	1962588491	1	1	JACOBS, DANIEL I MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58289	01	General Practice	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
8013	Fee-for-Service	1477578458	1477578458	1	1	JURY, MARK A OD	11/19/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC VISION EXPER	23905 CLINTON KEITH RD	STE 115	WILDOMAR	CA	92595	7899	33	06065	33.59624172	-117.2419728	Riverside County
8191	Fee-for-Service	1871682096	1871682096	1	1	JOSHI, C. R. MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	25562	01	General Practice	0	In state provider	None	1350 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2898	56	06111	34.27163453	-118.7729325	Ventura County
8195	Fee-for-Service	1023118098	1023118098	1	1	JAMIL, SHAZIA M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55261	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
8231	Fee-for-Service	1720626815	1720626815	1	1	JANETS ENTERPRISE INC	7/7/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6488 CAMBRIDGE ST	None	RANCHO CUCAMONGA	CA	91737	4211	36	06071	34.13625166	-117.5865247	San Bernardino County
8240	Fee-for-Service	1962588491	1962588491	1	1	JACOBS, DANIEL I MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58289	24	Plastic Surgery	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
8272	Fee-for-Service	1265843403	1265843403	1	1	JARIWALA, AMAR R MD	1/29/2019	207ZP0102X	NA	Other	026	PHYSICIANS	153035	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
8309	Fee-for-Service	1740487909	1740487909	1	1	JASON N ITRI MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 3950	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
8311	Fee-for-Service	1679329080	1679329080	1	1	JENKINS FAMILY NURSING MEDIC	6/24/2024	261QH0100X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	AL PRACTICE, INC	3333 CONCOURS	4200	ONTARIO	CA	91764	6547	36	06071	34.0749	-117.5787495	San Bernardino County
8334	Fee-for-Service	1528249638	1528249638	1	1	JACKSON, KATHERINE J NP	10/26/2018	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
8346	Fee-for-Service	1336251909	1336251909	1	1	JENNIFER REID MD	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
8377	Fee-for-Service	1104084698	1104084698	1	1	JACKSON, OLLIE J MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103543	08	Family Practice	0	In state provider	None	5125 MONTE VISTA STREET	None	LOS ANGELES	CA	90042	3931	19	06037	34.108303	-118.2015543	Los Angeles County
8387	Fee-for-Service	1740283084	1740283084	1	1	JONES-POLAND, EDITH A MD	9/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76482	01	General Practice	0	In state provider	INC	56970 YUCCA TRL	STE 103	YUCCA VALLEY	CA	92284	7911	36	06071	34.12059645	-116.420985	San Bernardino County
8471	Fee-for-Service	1851852438	1851852438	1	1	JIA, LEO MD	6/6/2024	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
8481	Fee-for-Service	1023118098	1023118098	1	1	JAMIL, SHAZIA M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55261	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
8540	Fee-for-Service	1326314675	1326314675	1	1	JETT, MARGARET D DO	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12542	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
8610	Fee-for-Service	1083258073	1083258073	1	1	JASUNG KIM PSYCHIATRIST CLIN	4/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	IC,APC	505 SHATTO PL	204	LOS ANGELES	CA	90020	1754	19	06037	34.06495103	-118.2899354	Los Angeles County
8642	Fee-for-Service	1184018145	1184018145	1	1	JIANG, JAMES MD	7/15/2019	207P00000X	NA	Other	026	PHYSICIANS	145803	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
8664	Fee-for-Service	1104084698	1104084698	1	1	JACKSON, OLLIE J MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103543	24	Plastic Surgery	0	In state provider	None	5125 MONTE VISTA STREET	None	LOS ANGELES	CA	90042	3931	19	06037	34.108303	-118.2015543	Los Angeles County
8737	Fee-for-Service	1083778542	1083778542	1	1	JONES-BEY, MARA T	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
8748	Fee-for-Service	1568525400	1568525400	1	1	JOHN R GLYER D MILLS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MATHESON & MARGARET ARNE	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
8786	Fee-for-Service	1700953791	1700953791	1	1	JONE, SEN H MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32275	02	General Surgery	0	In state provider	None	1355 FLORIN RD	STE 2	SACRAMENTO	CA	95822	4200	34	06067	38.496114	-121.5042525	Sacramento County
8845	Fee-for-Service	1124080650	1124080650	1	1	JENSEN, PERRY E MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42716	22	Pathology (M.D. only)	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
8846	Fee-for-Service	1477113926	1477113926	1	1	JHUN, MICHELLE	11/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20245	08	Family Practice	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
8880	Fee-for-Service	1518057116	1518057116	1	1	JONES, KIRTLY 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	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
8896	Fee-for-Service	1770780397	1770780397	1	1	JOHN YANG	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 MALCOLM X BLVD	None	NEW YORK	NY	10037	1802	00	None	40.81447535	-73.94040027	New York County
8904	Fee-for-Service	1043419989	1043419989	1	1	JONES, MELISSA M MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101838	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
8947	Fee-for-Service	1275640195	1275640195	1	1	JACKSON, VIOLETTE LCSW	2/3/2015	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	15525 POMERADO RD	E-4	POWAY	CA	92064	2427	37	06073	32.99479918	-117.0579468	San Diego County
8956	Fee-for-Service	1114105970	1114105970	1	1	JANRAY HOMES INC	10/11/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15695 HESSE DR	None	LA MIRADA	CA	90638	5447	19	06037	33.89177589	-117.9975436	Los Angeles County
8984	Fee-for-Service	1013123694	1013123694	1	1	JEW & JEW MEDICAL ASSOCIATES	6/16/1992	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	74351	41	Internal Medicine	0	In state provider	None	919 CLAY ST	None	SAN FRANCISCO	CA	94108	1520	38	06075	37.79398652	-122.4083496	San Francisco County
9015	Fee-for-Service	1417037466	1417037466	1	1	JAFFE, JOEL MD	2/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21950	01	General Practice	0	In state provider	None	7531 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	6401	19	06037	34.09081315	-118.3541261	Los Angeles County
9039	Fee-for-Service	1568525400	1568525400	1	1	JOHN R GLYER D MILLS	1/28/1993	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MATHESON & MARGARET ARNE	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
9071	Fee-for-Service	1679581581	1679581581	1	1	JOHNSON, STEVEN C MD	6/21/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38558	18	Ophthalmology	0	In state provider	None	628 CALIFORNIA BLVD	STE C	SAN LUIS OBISPO	CA	93401	2547	40	06079	35.28917428	-120.6578269	San Luis Obispo County
9084	Fee-for-Service	1144308214	1144308214	1	1	JIANG, WEI MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83226	18	Ophthalmology	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
9093	Fee-for-Service	1568903888	1568903888	1	1	JOHNSON, MAXWELL B MD	8/16/2024	208200000X	NA	General Surgery	026	PHYSICIANS	159221	24	Plastic Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
9112	Fee-for-Service	1871611228	1871611228	1	1	JOHNSON, OLIVIA PSYD	5/16/2025	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
9141	Fee-for-Service	1366885907	1366885907	1	1	JINKINS, LINDSAY J MD	10/17/2022	207L00000X	NA	Other	026	PHYSICIANS	172282	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
9162	Fee-for-Service	1811516354	1811516354	1	1	JENNINGS, MICHAEL	3/14/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187121	15	Obstetrics (D.O. only)	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
9179	Fee-for-Service	1891912259	1891912259	1	1	JANIGA, MATTHEW A MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110530	34	Urology and Urological Surgery	0	In state provider	None	3123 PROFESSIONAL DR	SUITE 210	AUBURN	CA	95603	2400	31	06061	38.9412	-121.100888	Placer County
9195	Fee-for-Service	1831162494	1831162494	1	1	JACOB, NADUVATHUSERY J MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55272	36	Psychiatry	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
9272	Fee-for-Service	1639674872	1639674872	1	1	JUWONO, TIMOTHY MD	8/14/2023	208800000X	NA	Other	026	PHYSICIANS	186256	None	None	0	In state provider	None	782 MEDICAL CENTER DR E	STE 311	CLOVIS	CA	93611	6892	10	06019	36.84379626	-119.6609117	Fresno County
9286	Fee-for-Service	1699836551	1699836551	1	1	JEUNG, JOAN J MD	4/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85106	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
9287	Fee-for-Service	1003255654	1003255654	1	1	JALIFE BUCAY, MAURICIO MD	1/6/2020	208M00000X	NA	Other	026	PHYSICIANS	166689	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
9295	Fee-for-Service	1285714972	1285714972	1	1	JANSSEN, SARAH J MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84125	47	Miscellaneous	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
9308	Fee-for-Service	1164924577	1164924577	1	1	JOYFUL HEARTS COMMUNITY	11/1/2018	251V00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	675 HEGENBERGER RD	STE 241	OAKLAND	CA	94621	1990	01	06001	37.74858108	-122.1964244	Alameda County
9326	Fee-for-Service	1568525400	1568525400	1	1	JOHN R GLYER D MILLS	1/28/1993	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MATHESON & MARGARET ARNE	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
9353	Fee-for-Service	1417952516	1417952516	1	1	JEFFREY A BRINK	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2218 N 3RD ST	None	PHOENIX	AZ	85004	1401	00	None	33.471855	-112.069719	Maricopa County
9390	Fee-for-Service	1841870177	1841870177	1	1	JO, ERIN MD	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	18035 BROOKHURST ST	SUITE 1300	FOUNTAIN VALLEY	CA	92708	6738	30	06059	33.701184	-117.9544385	Orange County
9421	Fee-for-Service	1679547517	1679547517	1	1	JULIE BETH MCCAUSLAND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	None	PITTSBURGH	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
9430	Fee-for-Service	1689734857	1689734857	1	1	JOHNSON, DANA R MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70148	08	Family Practice	0	In state provider	None	12600 BEACH BLVD	None	STANTON	CA	90680	4091	30	06059	33.77938183	-117.9926679	Orange County
9473	Fee-for-Service	1649504911	1649504911	2	1	J11 CONSULTING INC	6/22/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2212 E 4TH ST	STE 102	SANTA ANA	CA	92705	3870	30	06059	33.746706	-117.835191	Orange County
9615	Fee-for-Service	1568525400	1568525400	1	1	JOHN R GLYER D MILLS	6/9/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MATHESON & MARGARET ARNE	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
9620	Fee-for-Service	1851300974	1851300974	1	1	JUNCK, DANIEL L MD	1/1/2002	207R00000X	NA	Other	026	PHYSICIANS	50560	None	None	0	In state provider	None	3883 AIRWAY DR	202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
9650	Fee-for-Service	1093782831	1093782831	1	1	JAMES FORD MCDONNELL, 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
9652	Fee-for-Service	1770104879	1770104879	1	1	J&P MEDICAL TRANSPORT LLC	8/4/2023	2278P4000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6073 N FRESNO ST	SUITE 105	FRESNO	CA	93710	8614	10	06019	36.82404	-119.7814395	Fresno County
9657	Fee-for-Service	1881429355	1881429355	1	1	JOHNSON, ANALISA AU	2/10/2025	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
9660	Fee-for-Service	1427571983	1427571983	1	1	JINDAL, VIPUL MD	4/17/2023	208M00000X	NA	Other	026	PHYSICIANS	170598	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
9681	Fee-for-Service	1114180858	1114180858	1	1	JIAN, BRIAN J MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102389	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
9717	Fee-for-Service	1487177796	1487177796	1	1	JOHAL, JAIMAL S MD	10/5/2020	207R00000X	NA	Other	026	PHYSICIANS	166712	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
9795	Fee-for-Service	1457530784	1457530784	1	1	J.H. SUH MD INC	11/19/1996	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	639 SOUTH NEW HAMPSHIRE	AVE, SUITE 201	LOS ANGELES	CA	90005	1342	19	06037	34.062687	-118.2929295	Los Angeles County
9818	Fee-for-Service	1932625886	1932625886	1	1	JAKUBOWSKI, ALEKSANDRA I CRN	5/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9868	Fee-for-Service	1184183444	1184183444	1	1	JOHNSON, REBECCA J MD	4/25/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	180060	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
9931	Fee-for-Service	1376179952	1376179952	1	1	JOHN, KIMBERLY N	3/30/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	25558 MANDARIN CT.	None	LOMA LINDA	CA	92354	3713	36	06071	34.04404851	-117.2467215	San Bernardino County
9953	Fee-for-Service	1356011597	1356011597	1	1	JACKSON, CHANELL S CNM	3/15/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
10059	Fee-for-Service	1164634408	1164634408	1	1	JOSEPH ARAMPULIKAN	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
10070	Fee-for-Service	1275929879	1275929879	1	1	JIMMERSON, CATHERINE E NP	12/15/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
10091	Fee-for-Service	1821353418	1821353418	1	1	JONES, MEGAN E LCSW	6/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100407	-	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
10143	Fee-for-Service	1649224999	1649224999	1	1	JUNG, JAMES K DPM	4/24/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1045 ATLANTIC AVE	STE 807	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
10208	Fee-for-Service	1609273606	1609273606	1	1	JI, ANGELA X MD	10/13/2020	207L00000X	NA	Other	026	PHYSICIANS	150468	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
10219	Fee-for-Service	1376179952	1376179952	1	1	JOHN, KIMBERLY N	3/30/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	25558 MANDARIN CT.	None	LOMA LINDA	CA	92354	3713	36	06071	34.04404851	-117.2467215	San Bernardino County
10223	Fee-for-Service	1417903618	1417903618	1	1	JUSTIN THOLANY M.D.	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
10246	Fee-for-Service	1013414416	1013414416	1	1	JEFFERSON, CURTIS J LMFT	10/8/2023	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
10267	Fee-for-Service	1346437258	1346437258	1	1	JERCINOVICH, IGOR MD INC	8/6/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	56290	20	Orthopedic Surgery	0	In state provider	None	521 E ELDER	#105	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
10323	Fee-for-Service	1295330710	1295330710	1	1	JOHNSON, TARYN C LMFT	8/9/2023	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
10366	Fee-for-Service	1891391710	1891391710	1	1	JENSEN, MONIQUE A LMFT	12/19/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	151861	-	NOT APPLICABLE	0	In state provider	None	24953 PASEO DE VALENCIA	1B	LAGUNA HILLS	CA	92653	4340	30	06059	33.60028568	-117.7010887	Orange County
10414	Fee-for-Service	1881217008	1881217008	1	1	JOHNSON, ASHLEY R NP	11/14/2023	207R00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	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
10466	Fee-for-Service	1487688552	1487688552	1	1	JOHN W BARRETT	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1525 W 2100 S	None	SALT LAKE CTY	UT	84119	1407	00	None	40.72588117	-111.933134	Salt Lake County
10489	Fee-for-Service	1780800813	1780800813	1	1	JOSEPH HUNTER WOOLLEY M.D.	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	292 S 1470 E	STE 100	ST GEORGE	UT	84790	1764	00	None	37.10310593	-113.5517436	Washington County
10532	Fee-for-Service	1386611531	1386611531	1	1	JOHN,SABU	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
10563	Fee-for-Service	1104983360	1104983360	1	1	JOHNSON, FREDERICK L	8/26/1995	207L00000X	NA	Other	026	PHYSICIANS	55618	05	Anesthesiology	0	In state provider	None	5196 HILL RD E	STE 203	LAKEPORT	CA	95453	6362	17	06033	39.10527946	-122.9080599	Lake County
10584	Fee-for-Service	1922587377	1922587377	1	1	JOHNSON, KYLE DPM	4/4/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2345 E 8TH ST	SUITE 105	NATIONAL CITY	CA	91950	2866	37	06073	32.68268563	-117.082682	San Diego County
10668	Fee-for-Service	1669679569	1669679569	1	1	JOHN, CHRISTOPHER M DO	8/10/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20771	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
10819	Fee-for-Service	1790167492	1790167492	1	1	JUNG, GRACE A OD	1/21/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
10829	Fee-for-Service	1194783266	1194783266	1	1	JACOBS, JEFFREY L MD	9/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	83140	18	Ophthalmology	0	In state provider	None	2390 E FLORIDA AVE	STE 207	HEMET	CA	92544	4755	33	06065	33.7477405	-116.94681	Riverside County
10836	Fee-for-Service	1023044500	1023044500	1	1	JOBE, CHRISTOPHER M MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	46864	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	# 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
10894	Fee-for-Service	1780724286	1780724286	1	1	JONBEC CARE, INC	5/21/2003	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CANTERBURY HOUSE	13131 6TH PL	UNIT 2	YUCAIPA	CA	92399	2345	36	06071	34.01475809	-117.0624832	San Bernardino County
10896	Fee-for-Service	1164797452	1164797452	1	1	JUNG, CHRISTINA E MD	6/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116824	40	Pediatrics	0	In state provider	None	4650 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
10912	Fee-for-Service	1215019591	1215019591	2	1	JAIN, DAKSHA A MD	3/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	43228	40	Pediatrics	0	In state provider	None	1175 E ARROW HWY	STE M	UPLAND	CA	91786	5525	36	06071	34.09981647	-117.636003	San Bernardino County
10924	Fee-for-Service	1881941433	1881941433	1	2	JEFFREY KAPLAN, M.D. PEDIATR	7/6/2022	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IC MEDICINE, INC	821 E CHAPEL ST	STE 203	SANTA MARIA	CA	93454	4617	42	06083	34.95428347	-120.4236585	Santa Barbara County
10939	Fee-for-Service	1922678408	1922678408	1	1	JAVIER, JAASIEL CRNA	10/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 MAGELLAN DR.	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
10979	Fee-for-Service	1619428000	1619428000	1	1	JOHNSTON, CHRISTINA LMFT	12/2/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	530 OCEAN ST	UNIT A	SANTA CRUZ	CA	95060	6628	44	06087	36.97556123	-122.0192565	Santa Cruz County
11046	Fee-for-Service	1619037884	1619037884	1	1	JOHNS, RACHEL A DO	5/6/2008	207R00000X	NA	Other	026	PHYSICIANS	9416	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
11063	Fee-for-Service	1104916253	1104916253	1	1	JONG, KRISTINA L MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81074	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11143	Fee-for-Service	1528509718	1528509718	1	1	JOHNSON, MCKENNA M	7/17/2024	208M00000X	NA	Other	026	PHYSICIANS	161912	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
11148	Fee-for-Service	1184887143	1184887143	1	1	JALILI, MEHDI S MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113955	30	Radiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
11152	Fee-for-Service	1750468278	1750468278	1	1	JEWELL, SARAH A MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67970	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
11239	Fee-for-Service	1871521799	1871521799	1	1	JADALLAH, SAMI MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74491	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
11276	Fee-for-Service	1538574207	1538574207	1	1	JAWAHAR, ANUGAYATHRI	6/5/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162668	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11317	Fee-for-Service	1326058330	1326058330	1	1	JABRO, MARK N MD	11/30/1993	207R00000X	NA	Other	026	PHYSICIANS	52925	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
11320	Fee-for-Service	1912289778	1912289778	1	1	JUDSON, CHRISTINA L MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	89076	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
11341	Fee-for-Service	1487744090	1487744090	1	1	JOEL D MACDONALD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
11362	Fee-for-Service	1740220094	1740220094	1	1	JONES, SCOT B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40910	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
11366	Fee-for-Service	1851638381	1851638381	1	1	JOHNSON, JANE CCC-SLP	6/15/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9300 STOCKTON	200	ELK GROVE	CA	95758	8070	34	06067	38.419101	-121.3945425	Sacramento County
11424	Fee-for-Service	1740394139	1740394139	1	1	JONES BRUCE C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	79314	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
11462	Fee-for-Service	1598129686	1598129686	1	1	JOSHI, ROHAN P MD	6/16/2020	207ZP0101X	NA	Other	026	PHYSICIANS	150980	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
11509	Fee-for-Service	1538134523	1538134523	1	1	JEFFREY D OLIVER, M.D.	11/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	0000	00	None	33.480864	-112.0795155	Maricopa County
11650	Fee-for-Service	1427120658	1427120658	1	1	JENNINGS, MARY C MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55908	None	None	0	In state provider	None	4501 MISSION BAY DR	STE 1E	SAN DIEGO	CA	92109	4926	37	06073	32.80307971	-117.2166446	San Diego County
11685	Fee-for-Service	1548997422	1548997422	1	1	JUAN, GLORIFINO D NP	1/24/2024	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
11864	Fee-for-Service	1336235951	1336235951	1	1	JEFFREY B DUNN 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
11940	Fee-for-Service	1760555114	1760555114	1	1	JAM, NEDA OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
11975	Fee-for-Service	1043530587	1043530587	1	1	JASON ROBERT MORICH 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	1700 E 19TH ST	None	THE DALLES	OR	97058	3317	00	None	45.58806554	-121.164498	Wasco County
12124	Fee-for-Service	1225009632	1225009632	1	1	JOHN TRIEDMAN MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 LONGWOOD AVE	None	BOSTON	MA	02115	5724	00	None	42.337035	-71.105607	Suffolk County
12132	Fee-for-Service	1750449229	1750449229	1	1	JOHNSON, PAUL B MD	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93613	None	None	0	In state provider	None	7230 MEDICAL CENTER DR	STE 500	WEST HILLS	CA	91307	4024	19	06037	34.20172814	-118.6294322	Los Angeles County
12165	Fee-for-Service	1376530204	1376530204	1	1	JULIE CARLSON M.D.	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
12202	Fee-for-Service	1619317153	1619317153	1	1	JOHNSTON, LIAN P OD	8/23/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	202 W MYRTLE ST	None	HANFORD	CA	93230	3805	16	06031	36.3331043	-119.6481113	Kings County
12225	Fee-for-Service	1497288724	1497288724	1	1	JEU, KELLY A MD	7/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157005	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
12354	Fee-for-Service	1962856716	1962856716	1	1	JOHNSON, MICHAEL DO MD	9/1/2018	207P00000X	NA	Other	026	PHYSICIANS	None	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
12366	Fee-for-Service	1548687114	1548687114	1	1	JOHAL, KARANJODH S DO	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13614	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
12498	Fee-for-Service	1346437258	1346437258	1	2	JERCINOVICH, IGOR MD INC	8/6/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	56290	20	Orthopedic Surgery	0	In state provider	None	25150 HANCOCK AVE	SUITE 200	MURRIETA	CA	92562	5988	33	06065	33.56635084	-117.1823956	Riverside County
12576	Fee-for-Service	1114052818	1114052818	1	1	JACKSON, TENIKA L PHD	6/9/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
12595	Fee-for-Service	1790977874	1790977874	1	1	JOHAL, GURPREET DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9992	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
12608	Fee-for-Service	1427119791	1427119791	1	1	JULIAN, ROBERT S III MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63994	02	General Surgery	0	In state provider	INC	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
12760	Fee-for-Service	1720346604	1720346604	1	1	JACOBS, SANDRA E LMFT	8/28/2018	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
12763	Fee-for-Service	1124433610	1124433610	1	1	JACOB, JINSY A MD	5/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
12817	Fee-for-Service	1780632299	1780632299	1	1	JOHNSON, FRANKLIN M DO	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7957	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 SAN BERNARDINO RD	SUITE 201	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
12877	Fee-for-Service	1447274121	1447274121	1	1	JOHNSON, CAROLINA B OD	5/7/2018	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
12888	Fee-for-Service	1780638528	1780638528	1	1	JIANG, SIMON MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69991	01	General Practice	0	In state provider	None	1314 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1705	19	06037	34.05401581	-118.2671793	Los Angeles County
13137	Fee-for-Service	1285814764	1285814764	1	1	JOERKE, FRANK MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114494	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PRKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
13175	Fee-for-Service	1780638528	1780638528	1	1	JIANG, SIMON MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69991	40	Pediatrics	0	In state provider	None	1314 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1705	19	06037	34.05401581	-118.2671793	Los Angeles County
13189	Fee-for-Service	1780860502	1780860502	1	1	JWCH INSTITUTE INC	6/9/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	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
13203	Fee-for-Service	1467459479	1467459479	1	1	JAMES THOMAS WEBBER, MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	8919	00	None	40.56668579	-112.2959013	Tooele County
13288	Fee-for-Service	1285857706	1285857706	1	1	JOHN C FREMONT HEALTHCARE	10/1/1979	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5108 HIGHWAY 140	SUITE C	MARIPOSA	CA	95338	9208	22	06043	37.48928689	-119.9700043	Mariposa County
13380	Fee-for-Service	1811973555	1811973555	1	1	JOHNSON-PATEL, JENNIFER M MD	5/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86243	40	Pediatrics	0	In state provider	None	3544 30TH STREET	None	SAN DIEGO	CA	92104	4120	37	06073	32.742936	-117.130118	San Diego County
13450	Fee-for-Service	1508965369	1508965369	1	1	JUNE NEELEY	7/31/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1006 W MAIN ST	None	BOZEMAN	MT	59715	3219	00	None	45.67905	-111.0511575	Gallatin County
13509	Fee-for-Service	1346442308	1346442308	1	1	JI, LYNN L MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97560	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
13556	Fee-for-Service	1285991299	1285991299	1	1	JERRY WAYNE CATT JR.	11/29/2015	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
13600	Fee-for-Service	1538481643	1538481643	1	2	JIMENEZ JONES, ROSE A LPCC	3/7/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSELING	102 SCHOOL STREET	None	CORONA	CA	92882	1949	33	06065	33.88180808	-117.571604	Riverside County
13734	Fee-for-Service	1164672572	1164672572	1	1	JAMES VAN SIATRAS D.O.	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7895 GRAND BLVD	None	HOBART	IN	46342	6665	00	None	41.474853	-87.257169	Lake County
13759	Fee-for-Service	1851302889	1851302889	1	1	JAVIER, MARICOR C MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106443	40	Pediatrics	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
13766	Fee-for-Service	1386844637	1386844637	1	1	JOHNSON, COURTNEY N MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129878	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
13858	Fee-for-Service	1275582223	1275582223	1	1	JOSELSON, RAE A MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	47140	22	Pathology (M.D. only)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
13913	Fee-for-Service	1669424149	1669424149	1	1	J MICHAEL ROSEBERRY MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6468	00	None	47.8799292	-122.2332137	Snohomish County
13946	Fee-for-Service	1669977633	1669977633	1	1	JOHNSON, KELSEY M MD	8/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166774	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
14036	Fee-for-Service	1083607949	1083607949	1	1	JONES, MICHAEL J	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15786 SPRINGDALE ST	None	HUNTINGTON BEACH	CA	92649	1316	30	06059	33.730938	-118.024032	Orange County
14049	Fee-for-Service	1295996064	1295996064	1	1	JAFFER, A K MD INC	12/7/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	33626	41	Internal Medicine	0	In state provider	None	1011 E DEVONSHIRE AVE	STE 102	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
14056	Fee-for-Service	1427083187	1427083187	1	1	JONES, CLIFFORD RAY	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42987	08	Family Practice	0	In state provider	None	3302 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.5823206	-124.1359965	Humboldt County
14086	Fee-for-Service	1790904944	1790904944	1	1	JOHNSON, PERRI W PHD	12/1/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	THE CTR FOR NEUROTHERAPY	3330 BARHAM BLVD	STE 102	LOS ANGELES	CA	90068	1476	19	06037	34.13158124	-118.3446679	Los Angeles County
14116	Fee-for-Service	1629244553	1629244553	1	1	JAMORA, CHRISTINA Y W PHD	4/18/2018	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
14132	Fee-for-Service	1881792596	1881792596	1	1	JEDI VENTURES, LLC	7/1/1998	261QS0132X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SACRAMENTO EYE SURGICTR	3150 J ST	None	SACRAMENTO	CA	95816	4403	34	06067	38.57230866	-121.4637227	Sacramento County
14329	Fee-for-Service	1558433623	1558433623	1	1	JURKA, ELZBIETA W MD	10/31/1996	207ZP0102X	NA	Other	026	PHYSICIANS	45644	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
14335	Fee-for-Service	1295996064	1295996064	1	1	JAFFER, A K MD INC	12/7/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	33626	13	Neurology (M.D. only)	0	In state provider	None	1011 E DEVONSHIRE AVE	STE 102	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
14438	Fee-for-Service	1417979949	1417979949	1	1	JUOZOKAS, ALISON L MD	7/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95752	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 304	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
14442	Fee-for-Service	1598879082	1598879082	1	1	JONES, LEONARD P MD	4/30/1988	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43105	36	Psychiatry	0	In state provider	None	5200 SAN GABRIEL PL	STE E	PICO RIVERA	CA	90660	2498	19	06037	33.99848052	-118.0840108	Los Angeles County
14485	Fee-for-Service	1154384261	1154384261	1	1	JAIRATH, UMESH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	415 WEST COLUMBIA ST	None	EVANSVILLE	IN	47710	1656	00	None	37.98486618	-87.56985734	Vanderburgh County
14589	Fee-for-Service	1184769358	1184769358	1	2	JONES, NAVELLE MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	46469	40	Pediatrics	0	In state provider	None	403 S LONG BEACH BLVD	STE B	COMPTON	CA	90221	3491	19	06037	33.89318091	-118.2078742	Los Angeles County
14692	Fee-for-Service	1144589979	1144589979	1	1	JAMES, CHRISTINE K MD	9/1/2021	207K00000X	NA	Other	026	PHYSICIANS	172774	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
14731	Fee-for-Service	1023249802	1023249802	1	1	JANG, JENNIFER H MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97998	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
14750	Fee-for-Service	1104391275	1104391275	1	1	JOSHI, RAJIV LMFT	8/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2524 WHISPERING TRL	None	IRVINE	CA	92602	0826	30	06059	33.73936812	-117.7646833	Orange County
14768	Fee-for-Service	1093897506	1093897506	1	1	JEFFREY SALOMONE	9/12/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
14780	Fee-for-Service	1407353840	1407353840	1	1	JOYFUL HOME CORPORATION	11/18/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	25232 COSTEAU ST	None	LAGUNA HILLS	CA	92653	5026	30	06059	33.59947013	-117.689584	Orange County
14820	Fee-for-Service	1174702377	1174702377	1	2	JEREMY IAN GROSSER, M.D., IN	9/27/2022	282N00000X	NA	Hospitals	026	PHYSICIANS	None	None	None	0	In state provider	C.	22029 SATICOY ST	None	CANOGA PARK	CA	91303	1133	19	06037	34.20833477	-118.6075568	Los Angeles County
14821	Fee-for-Service	1053536458	1053536458	1	1	JAIN, SUPARNA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80932	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
14927	Fee-for-Service	1023217502	1023217502	1	1	JANECZEK, LUKASZ MD	11/10/2024	208M00000X	NA	Other	026	PHYSICIANS	157968	08	Family Practice	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
15034	Fee-for-Service	1639506975	1639506975	1	1	JONAS, ANDREW W LMFT	5/20/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	515 EAST 6TH STREET	9TH FLOOR	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
15064	Fee-for-Service	1518238856	1518238856	1	1	JACKSON, KRISTYN N MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118911	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
15074	Fee-for-Service	1063929529	1063929529	1	1	JANG, JULIE K MD	8/22/2022	2085R0001X	NA	Other	026	PHYSICIANS	159828	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
15107	Fee-for-Service	1366101255	1366101255	1	1	JIMENEZ-GRANDI, SARAH A LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
15111	Fee-for-Service	1053536458	1053536458	1	1	JAIN, SUPARNA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80932	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
15148	Fee-for-Service	1356512560	1356512560	1	1	JEREMY CADE CHRISTENSEN	4/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3740 DACORO LN	STE 105	CASTLE ROCK	CO	80109	2515	00	None	39.4004309	-104.8785078	Douglas County
15157	Fee-for-Service	1255730859	1255730859	1	1	JENKINS, WILLOUGH A MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132206	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
15285	Fee-for-Service	1497075311	1497075311	1	1	JUNIOUS, SHAQUITA R LMFT	8/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12304 SANTA MONICA BLVD	215	LOS ANGELES	CA	90025	2551	19	06037	34.03948285	-118.4656304	Los Angeles County
15316	Fee-for-Service	1407313356	1407313356	1	1	JOHNSTON, ACEL LMFT INC	9/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	SUITE 121	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
15330	Fee-for-Service	1558745851	1558745851	1	1	JOELLE M VOGLTANCE APRN	8/16/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
15383	Fee-for-Service	1316525504	1316525504	1	1	JAVED, QASIM MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	22784	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
15555	Fee-for-Service	1235675711	1235675711	1	1	JONES, LUKE D MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	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
15592	Fee-for-Service	1013083179	1013083179	1	1	JAFARZADEH-KHOSRAVI,M	11/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66815	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
15678	Fee-for-Service	1215263835	1215263835	1	1	JBAENS CORPORATION	4/3/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3532 CLAYTON ROAD	None	CONCORD	CA	94519	2447	07	06013	37.97054201	-122.0115137	Contra Costa County
15680	Fee-for-Service	1518304146	1518304146	1	1	JHK HERITAGE INC	2/11/2014	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	3339 WEST TEMPLE ST	None	LOS ANGELES	CA	90026	4523	19	06037	34.07606571	-118.2828755	Los Angeles County
15714	Fee-for-Service	1053395848	1053395848	1	1	JOHNS, BERT J III MD	3/28/1988	208600000X	NA	General Surgery	026	PHYSICIANS	62546	02	General Surgery	0	In state provider	None	1800 SULLIVAN AVE	STE 507	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
15738	Fee-for-Service	1578767232	1578767232	1	1	JOHNSON, GADSON J JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100422	36	Psychiatry	0	In state provider	None	701 SANTA MONICA BLVD.	SUITE 230	SANTA MONICA	CA	90401	2623	19	06037	34.01898426	-118.4921034	Los Angeles County
15778	Fee-for-Service	1861570491	1861570491	1	1	JACKSON, CHARLES E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29026	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
15813	Fee-for-Service	1952399321	1952399321	1	2	JANIC, BILJANA MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
15859	Fee-for-Service	1013083179	1013083179	1	1	JAFARZADEH-KHOSRAVI,M	11/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66815	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
15914	Fee-for-Service	1306809025	1306809025	1	1	JENSEN, WILLIAM A MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	45285	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
15925	Fee-for-Service	1992201297	1992201297	1	1	JENSEN, STEPHANIE MD	3/12/2024	208800000X	NA	Other	026	PHYSICIANS	164065	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
16052	Fee-for-Service	1477105872	1477105872	1	1	JOSEPH, ANNE LMFT	5/19/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2801 BRISTOL STREET	STE 200	COSTA MESA	CA	92626	5996	30	06059	33.67474907	-117.889122	Orange County
16070	Fee-for-Service	1437156056	1437156056	1	1	JOUBERT-GREENE, PAULA MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45542	08	Family Practice	0	In state provider	None	4811 ELISABETH ST	None	CUDAHY	CA	90201	0000	19	06037	33.96297909	-118.1837139	Los Angeles County
16108	Fee-for-Service	1871857383	1871857383	1	1	JONES, JAMES H MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129183	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
16151	Fee-for-Service	1528298031	1528298031	1	1	JUN, CHRISTINE S MD	7/7/2020	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	161595	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
16156	Fee-for-Service	1881705556	1881705556	2	1	JORGE R. LOPEZ, M.D.	5/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71947	41	Internal Medicine	0	In state provider	None	2740 S. BRISTOL ST.	SUITE 100	SANTA ANA	CA	92704	6232	30	06059	33.70999696	-117.8854626	Orange County
16203	Fee-for-Service	1306809025	1306809025	1	1	JENSEN, WILLIAM A MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	45285	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
16206	Fee-for-Service	1457318347	1457318347	1	1	JOO, KATHY K MD	9/4/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	None	None	0	In state provider	None	29645 RANCHO CALIFORNIA	SUITE 134	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
16277	Fee-for-Service	1235665167	1235665167	1	1	JOHNSON, ERNEST CRNA	1/19/2021	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
16361	Fee-for-Service	1437156056	1437156056	1	1	JOUBERT-GREENE, PAULA MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45542	01	General Practice	0	In state provider	None	4811 ELISABETH ST	None	CUDAHY	CA	90201	0000	19	06037	33.96297909	-118.1837139	Los Angeles County
16390	Fee-for-Service	1588708671	1588708671	1	1	JOHNSON, JENNIFER LMFT	9/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
16515	Fee-for-Service	1447784566	1447784566	1	1	JICHA, CRYSTAL J MD	8/30/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	177238	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
16656	Fee-for-Service	1316626765	1316626765	1	1	JUNGERS, ARCH NP	6/19/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1161 E COVINA BLVD	None	COVINA	CA	91724	1523	19	06037	34.09946746	-117.8671905	Los Angeles County
16746	Fee-for-Service	1699207266	1699207266	1	1	JOBSON, MEGHAN A MD	8/17/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	161219	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
16761	Fee-for-Service	1790754885	1790754885	1	1	JENSEN, ELSE M MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68533	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
16837	Fee-for-Service	1497235683	1497235683	1	1	JUAREZ, JOSE L LCSW	4/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
16882	Fee-for-Service	1740786870	1740786870	1	1	JENSEN, SARAH M MD	4/19/2021	207R00000X	NA	Other	026	PHYSICIANS	166298	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
16915	Fee-for-Service	1346354172	1346354172	1	1	JOHN BRENTON MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
16938	Fee-for-Service	1760768964	1760768964	1	1	JOAQUIN, KAREN LMFT	12/12/2024	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
17005	Fee-for-Service	1578823613	1578823613	1	1	JONATHAN FARKAS, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
17012	Fee-for-Service	1457556003	1457556003	1	1	JOHN NGUYEN,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 STADIUM DR	None	MORGANTOWN	WV	26506	7900	00	None	39.65330334	-79.95441785	Monongalia County
17016	Fee-for-Service	1700206042	1700206042	1	1	JINA, ASMITA A DO	7/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17387	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
17053	Fee-for-Service	1790754885	1790754885	1	1	JENSEN, ELSE M MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68533	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
17085	Fee-for-Service	1396384442	1396384442	1	1	JEFFREY BOYD INC.	1/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10832 LAUREL	STE 102	RANCHO CUCAMONGA	CA	91730	3865	36	06071	34.10486789	-117.5684863	San Bernardino County
17102	Fee-for-Service	1467567834	1467567834	1	1	JOYNER, IRA T MD	12/31/1986	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	30252	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7501 HOSPITAL DR	STE 304	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
17111	Fee-for-Service	1740495035	1740495035	1	1	JONES, CHRISTOPHER S LMFT	9/29/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53988	-	NOT APPLICABLE	0	In state provider	None	20094 MISSION BLVD	None	HAYWARD	CA	94541	1237	01	06001	37.68697869	-122.1024518	Alameda County
17122	Fee-for-Service	1922417765	1922417765	1	1	JEWISON, AMBER NP	3/7/2023	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
17143	Fee-for-Service	1881047181	1881047181	1	1	JIVRAJ, SANA MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142015	01	General Practice	0	In state provider	None	1141 PEAR TREE LN	STE 100	NAPA	CA	94558	2921	28	06055	38.32125908	-122.2921523	Napa County
17152	Fee-for-Service	1295806040	1295806040	1	1	JONES, MARILYN C MD	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30850	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
17208	Fee-for-Service	1811969116	1811969116	1	1	JONES, SHARI F CRNA	6/22/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5176 HILL RD E.	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
17367	Fee-for-Service	1497821482	1497821482	1	1	JOCSON, JENNIFER P MD	6/11/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97630	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
17384	Fee-for-Service	1003836024	1003836024	1	1	JEFFERY L BLEAZARD M.D.	10/19/2015	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
17410	Fee-for-Service	1861048084	1861048084	1	1	JWCH INSTITUTE INC	7/16/2020	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	858 WEST JACKMAN STREET	STE 101	LANCASTER	CA	93534	2488	19	06037	34.70091631	-118.1469103	Los Angeles County
17436	Fee-for-Service	1144450131	1144450131	1	1	JEREMY CLYDE RACEY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
17437	Fee-for-Service	1093705428	1093705428	1	1	JACKSON MADISON COUNTY GENER	8/20/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AL HOSPITAL	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
17524	Fee-for-Service	1205928660	1205928660	1	1	JENKINS, CHARLES C MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9096	02	General Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 101	OAKLAND	CA	94609	3115	01	06001	37.82079728	-122.2633226	Alameda County
17594	Fee-for-Service	1063568731	1063568731	1	1	JONES, R CARTER W III MD	7/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102894	05	Anesthesiology	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
17616	Fee-for-Service	1821446030	1821446030	1	1	JADE PHARMACY	6/12/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	34460 FREMONT BLVD	SUITE B	FREMONT	CA	94555	3324	01	06001	37.57436804	-122.0393136	Alameda County
17618	Fee-for-Service	1194816272	1194816272	1	1	JONES, JEFFRY H MD	10/14/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	81725	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	STE 260	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
17622	Fee-for-Service	1386929453	1386929453	1	1	JONES, ERIKA L MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122663	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
17639	Fee-for-Service	1407938632	1407938632	1	1	JAIN, VIJAY K MD	12/9/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	172171	None	None	0	In state provider	None	2222 EAST STREET	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
17725	Fee-for-Service	1093705428	1093705428	1	1	JACKSON MADISON COUNTY GENER	8/20/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AL HOSPITAL	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
17810	Fee-for-Service	1669520599	1669520599	1	1	JONG MARIA C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	84032	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
17855	Fee-for-Service	1134682008	1134682008	1	1	JANZ FAMILY THERAPY INCORPOR	4/12/2024	101Y00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ATED	6089 NORTH FIRST STREET	STE 104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
17887	Fee-for-Service	1154646537	1154646537	1	1	JUTRIC, ZELJKA MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143419	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
17906	Fee-for-Service	1194816272	1194816272	1	1	JONES, JEFFRY H MD	10/14/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	81725	41	Internal Medicine	0	In state provider	None	500 UNIVERSITY AVE	STE 260	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
17925	Fee-for-Service	1861638710	1861638710	1	1	JAMIESON, PETER M MD INC	11/19/2009	193400000X	NA	Other	026	PHYSICIANS	53447	02	General Surgery	0	In state provider	None	555 TACHEVAH DRIVE	SUITE 1W201	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
17934	Fee-for-Service	1174657902	1174657902	1	1	JOHNSON, HEATHER J PSYD	9/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	101 S KRAEMER BLVD	SUITE 114	PLACENTIA	CA	92870	6105	30	06059	33.87035522	-117.8630104	Orange County
18068	Fee-for-Service	1386306116	1386306116	1	1	JUNKO JOHNSON MARRIAGE & FAM	8/15/2022	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MILY THERAPY PROFESSIONA	25255 CABOT RD	SUIT 228	LAGUNA HILLS	CA	92653	5529	30	06059	33.59595988	-117.6763288	Orange County
18145	Fee-for-Service	1134682008	1134682008	1	1	JANZ FAMILY THERAPY INCORPOR	6/27/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ATED	6089 NORTH FIRST STREET	STE 104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
18147	Fee-for-Service	1518044577	1518044577	1	1	JEFFREY LEE VAAGEN,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 S MAIN AVE	None	RUGBY	ND	58368	2118	00	None	48.36333726	-99.99613832	Pierce County
18208	Fee-for-Service	1447261995	1447261995	1	1	JOST-VU, ELKE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44759	41	Internal Medicine	0	In state provider	KIEWIT BLDG #402	40055 BOB HOPE DR	STE F	RANCHO MIRAGE	CA	92270	3940	33	06065	33.75735051	-116.4082747	Riverside County
18245	Fee-for-Service	1689791642	1689791642	1	1	JENKINS-ETTER, CATHY E	5/16/2011	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
18308	Fee-for-Service	1033326863	1033326863	1	1	JUAN PABLO II MEDICAL CLINIC	10/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52551	None	None	0	In state provider	INC A PROFESSIONAL CORP	7402 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	5745	19	06037	33.97202774	-118.2224307	Los Angeles County
18354	Fee-for-Service	1093993024	1093993024	1	1	JOHNS, ANGELA A NP	10/24/2018	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
18418	Fee-for-Service	1174028955	1174028955	1	1	JOSHI, ARPITA A MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	173912	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
18528	Fee-for-Service	1437150604	1437150604	1	1	JENG, LINDA J MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79967	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	BOX 0648	SAN FRANCISCO	CA	94122	0648	38	06075	37.76332993	-122.4582988	San Francisco County
18707	Fee-for-Service	1760554240	1760554240	1	1	JOHNSON, BONNIE J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22993	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
18713	Fee-for-Service	1437649704	1437649704	1	1	JIANG, NING	1/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
18732	Fee-for-Service	1952301020	1952301020	1	1	JONES, WHAY H MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84706	01	General Practice	0	In state provider	None	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	44	06087	36.962588	-122.0439201	Santa Cruz County
18738	Fee-for-Service	1124515119	1124515119	1	2	JEFFREY BROOKS MD INC	7/17/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5120 MANZANITA AVE	STE 105	CARMICHAEL	CA	95608	0590	34	06067	38.659392	-121.327155	Sacramento County
18754	Fee-for-Service	1801394093	1801394093	1	1	JACKSON, APRIL B CCC-SLP	12/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
18769	Fee-for-Service	1710916861	1710916861	1	1	JOHNSTON, MICHELLE F CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
18845	Fee-for-Service	1912449802	1912449802	1	1	JOVELLANOS, CLARISSA LCSW	2/26/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
18895	Fee-for-Service	1124282454	1124282454	1	1	JONES, RACHEL	12/19/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
18936	Fee-for-Service	1508117730	1508117730	1	1	JONES, KARYN M LMFT	10/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W 1ST ST	STE 214	CLAREMONT	CA	91711	4743	19	06037	34.09450024	-117.7183344	Los Angeles County
18973	Fee-for-Service	1033159603	1033159603	1	1	JORDAN VALLEY HOSPITAL	5/11/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3580 W 9000 S	None	WEST JORDAN	UT	84088	8899	00	None	40.590153	-111.974634	Salt Lake County
18976	Fee-for-Service	1578001210	1578001210	1	1	JEAN, SHEILA B OT	1/22/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
19011	Fee-for-Service	1376726182	1376726182	1	1	JAZAYERI, MICHAEL MD INC	8/16/2018	193400000X	NA	Other	026	PHYSICIANS	73210	24	Plastic Surgery	0	In state provider	None	2010 E FIRST ST	SUITE 270	SANTA ANA	CA	92705	4083	30	06059	33.74554507	-117.8387522	Orange County
19012	Fee-for-Service	1902895782	1902895782	1	1	JOHNSON, PAUL C MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3006 S MARYLAND PRKWY	STE 315	LAS VEGAS	NV	89109	2313	00	None	36.135288	-115.1368705	Clark County
19017	Fee-for-Service	1558918268	1558918268	1	1	JONES, JACYLYN LMFT	8/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
19119	Fee-for-Service	1053419440	1053419440	1	1	JOHNSON, CHRISTOPHER MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67760	66	Emergency Medicine (Urgent Care)	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
19137	Fee-for-Service	1952697179	1952697179	1	1	JAVED, JEFFREY K MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139963	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
19204	Fee-for-Service	1194873927	1194873927	1	1	JAHAN-PARWAR, BOBBIE MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72147	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
19257	Fee-for-Service	1033159603	1033159603	1	1	JORDAN VALLEY HOSPITAL	5/11/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3580 W 9000 S	None	WEST JORDAN	UT	84088	8899	00	None	40.590153	-111.974634	Salt Lake County
19303	Fee-for-Service	1902895782	1902895782	1	1	JOHNSON, PAUL C MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	04	Otology, Laryngology, Rhinology	1	Border provider	None	3006 S MARYLAND PRKWY	STE 315	LAS VEGAS	NV	89109	2313	00	None	36.135288	-115.1368705	Clark County
19358	Fee-for-Service	1912391897	1912391897	1	1	JUHL, MARK E MD	10/12/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	162860	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
19424	Fee-for-Service	1952697179	1952697179	1	1	JAVED, JEFFREY K MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139963	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
19444	Fee-for-Service	1881772531	1881772531	1	1	JONG, EMILY Z MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82157	07	Dermatology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
19476	Fee-for-Service	1386140085	1386140085	1	1	JACKSON, MADELEINE E MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185904	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
19495	Fee-for-Service	1942599048	1942599048	1	1	JONATHAN CHARLES OLIVAS MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
19498	Fee-for-Service	1518079565	1518079565	1	1	JACKSON, BLAINE K MD	1/1/2002	207R00000X	NA	Other	026	PHYSICIANS	67288	41	Internal Medicine	0	In state provider	None	530 LOMAS SANTA FE DR	STE M	SOLANA BEACH	CA	92075	1346	37	06073	32.99511173	-117.2659419	San Diego County
19511	Fee-for-Service	1548238819	1548238819	1	1	JEN KIN, JAMES H MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	28982	36	Psychiatry	0	In state provider	None	4510 E PACIFIC COAST HWY	STE 120	LONG BEACH	CA	90804	6939	19	06037	33.78815204	-118.1400821	Los Angeles County
19557	Fee-for-Service	1639192057	1639192057	1	1	JIMENEZ, DANIEL MD INC	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75231	08	Family Practice	0	In state provider	None	801 N TUSTIN AVE	STE 601	SANTA ANA	CA	92705	3610	30	06059	33.752286	-117.8341735	Orange County
19581	Fee-for-Service	1912392887	1912392887	1	1	JAMISON, DALE K MD	6/14/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	166971	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19586	Fee-for-Service	1033476486	1033476486	1	1	JOSEPH, AMIT T MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127328	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19666	Fee-for-Service	1922384734	1922384734	1	1	JOPLIN, MOLLY PSYD	1/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
19767	Fee-for-Service	1851307540	1851307540	1	1	JANET T KEMPIS	12/12/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CORINTHIAN CARE CENTER	18460 ALLENDALE AVE	None	SARATOGA	CA	95070	5233	43	06085	37.2668615	-121.9935645	Santa Clara County
19768	Fee-for-Service	1831558261	1831558261	1	1	JAGPAL, SUNDIP K MD	7/1/2022	2279E0002X	NA	Other	026	PHYSICIANS	177376	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
19800	Fee-for-Service	1154325793	1154325793	1	1	JOHN F. MEGA M.D.	8/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 KANAWHA BLVD E	None	CHARLESTON	WV	25301	2400	00	None	38.34470937	-81.63296112	Kanawha County
19808	Fee-for-Service	1437406089	1437406089	1	2	JESTER, GEENA MD	2/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122313	01	General Practice	0	In state provider	None	595 CENTER AVE	STE 300	MARTINEZ	CA	94553	4634	07	06013	37.99313048	-122.1189497	Contra Costa County
19906	Fee-for-Service	1366644957	1366644957	1	1	JIN, MANLIN MD	3/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97844	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
19912	Fee-for-Service	1578620571	1578620571	1	2	JUREWITZ, WILLIAM H MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	27889	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
19967	Fee-for-Service	1063508851	1063508851	1	1	JAVAID,BASIT MD	10/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	61297	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
20004	Fee-for-Service	1649381740	1649381740	1	1	JOHNSON, DOUGLAS R DO	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	500 5TH STREET	None	BROOKINGS	OR	97415	9702	00	None	42.056721	-124.2879845	Curry County
20010	Fee-for-Service	1760462535	1760462535	1	1	JAMES-BECKHAM, LAURA	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67179	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
20076	Fee-for-Service	1891944500	1891944500	1	1	JIMENEZ, ELIA I PHD	5/5/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	950 S EUCLID AVE	None	SAN DIEGO	CA	92113	6201	37	06073	32.696181	-117.085139	San Diego County
20090	Fee-for-Service	1821070459	1821070459	1	1	JORDAN, TAMIKO A MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81023	40	Pediatrics	0	In state provider	None	900 S MAIN ST	STE 209A	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
20095	Fee-for-Service	1437406089	1437406089	1	2	JESTER, GEENA MD	2/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122313	08	Family Practice	0	In state provider	None	595 CENTER AVE	STE 300	MARTINEZ	CA	94553	4634	07	06013	37.99313048	-122.1189497	Contra Costa County
20105	Fee-for-Service	1154587582	1154587582	1	1	JANOSIK, DONNA LMFT	9/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1136 FREMONT AVE	STE 101	SOUTH PASADENA	CA	91030	3249	19	06037	34.11236286	-118.1531171	Los Angeles County
20160	Fee-for-Service	1881772614	1881772614	1	1	JOSEPH, ABED Y MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78039	02	General Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
20180	Fee-for-Service	1396071346	1396071346	1	1	JEWETT, JUDITH E CCC-SLP	10/19/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1849 WILLOW PASS RD.	SUITE 420	CONCORD	CA	94520	2524	07	06013	37.97486759	-122.0377305	Contra Costa County
20253	Fee-for-Service	1063508851	1063508851	1	1	JAVAID,BASIT MD	10/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	61297	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
20346	Fee-for-Service	1659379907	1659379907	1	1	JUMPER, ALFRED D MD APC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40961	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
20403	Fee-for-Service	1205329471	1205329471	1	1	JONES, WILLIAM R MD	11/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174446	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
20440	Fee-for-Service	1740351725	1740351725	1	1	JONAS, GAVIN M MD	5/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43668	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
20623	Fee-for-Service	1457018152	1457018152	1	1	JEZIOREK, ALEXANDER LMFT	3/31/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2340 WARD ST	106	BERKELEY	CA	94705	1124	01	06001	37.86026197	-122.2604161	Alameda County
20713	Fee-for-Service	1699742882	1699742882	1	1	JONES, THOMAS H	12/16/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	2410 FLETCHER AVE	3RD FLOOR	SANTA BARBARA	CA	93105	4876	42	06083	34.43003406	-119.7251391	Santa Barbara County
20734	Fee-for-Service	1740351725	1740351725	1	1	JONAS, GAVIN M MD	5/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43668	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
20738	Fee-for-Service	1962068015	1962068015	1	1	JENNIFER J. WILLIAMS	4/22/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	INC.	525 W ACACIA ST	None	STOCKTON	CA	95203	2484	39	06077	37.9611947	-121.3009489	San Joaquin County
20789	Fee-for-Service	1295820694	1295820694	1	1	JARVIK, JEFFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HARBORVIEW MED CTR	1959 NE PACIFIER ST	None	SEATTLE	WA	98195	9110	00	None	0	0	None
20806	Fee-for-Service	1164421939	1164421939	1	1	JOYCE, WILLIAM B MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37565	01	General Practice	0	In state provider	None	18550 DE PAUL DR	STE 208	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
20817	Fee-for-Service	1982984936	1982984936	1	1	JAFFE-MCAWEENEY, KAREN A LCS	9/3/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4113 SKYMONT DR	None	BELMONT	CA	94002	1243	41	06081	37.51681331	-122.3244562	San Mateo County
20839	Fee-for-Service	1891255345	1891255345	1	1	JOHANSEN, SARA L MD	7/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180750	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20879	Fee-for-Service	1316111743	1316111743	1	1	JOHANSEN-WILLIAMS, ALEXIS A	9/28/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	102689	-	NOT APPLICABLE	0	In state provider	MD	1625 CARROLL STREET	2ND FLOOR	SAN FRANCISCO	CA	94124	3219	38	06075	37.72518613	-122.3938382	San Francisco County
20938	Fee-for-Service	1376763938	1376763938	1	1	JONES, JOHANNA MFT	12/6/2017	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	280 E THOUSAND OAKS BLVD	STE D	THOUSAND OAKS	CA	91360	3150	56	06111	34.17914886	-118.872261	Ventura County
21088	Fee-for-Service	1568966968	1568966968	1	1	JANGHALA, ABHINAV MD	7/4/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	166125	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
21093	Fee-for-Service	1164421939	1164421939	1	1	JOYCE, WILLIAM B MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37565	41	Internal Medicine	0	In state provider	None	18550 DE PAUL DR	STE 208	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
21135	Fee-for-Service	1134456510	1134456510	1	1	JUSTIN PAQUETTE MD CORPORATI	7/8/2021	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ON	935 TRANCAS	STE 4B	NAPA	CA	94558	2943	28	06055	38.32367324	-122.294977	Napa County
21145	Fee-for-Service	1194906107	1194906107	1	1	JOHNSON, JOSEPH K MD	12/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147537	41	Internal Medicine	0	In state provider	None	999 S FAIRMONT AVE	130	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
21176	Fee-for-Service	1174521306	1174521306	1	1	JEON, GRACE H	5/9/2019	208600000X	NA	General Surgery	026	PHYSICIANS	84081	02	General Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 705	ANAHEIM	CA	92801	2814	30	06059	33.84718298	-117.933758	Orange County
21193	Fee-for-Service	1578889960	1578889960	1	1	JAGANATH, RAJESH MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119670	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
21207	Fee-for-Service	1780615013	1780615013	1	1	JOHNS, DONALD W MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	79	Neurology-Child	2	Out of state provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
21217	Fee-for-Service	1205913753	1205913753	1	1	JOHNSON, LLOYD E MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71511	41	Internal Medicine	0	In state provider	None	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
21279	Fee-for-Service	1134271109	1134271109	1	1	JAIN, VANDANA MD	4/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74226	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
21385	Fee-for-Service	1932287422	1932287422	1	1	JIANG, WENJI MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73400	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
21388	Fee-for-Service	1952554214	1952554214	1	1	JASON NEAL MACTAGGART 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
21391	Fee-for-Service	1477780906	1477780906	1	1	JONATHAN REDING	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
21422	Fee-for-Service	1669242616	1669242616	1	1	JANETTE Y VOTAW ACUPUNCTURE	3/11/2024	261Q00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1560 HUMBOLDT RD	STE. 5	CHICO	CA	95928	9101	04	06007	39.73644421	-121.8121391	Butte County
21490	Fee-for-Service	1720032980	1720032980	1	2	JOAQUIN, ARNEL M MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51799	-	NOT APPLICABLE	0	In state provider	None	1030 W FLORENCE AVE	None	LOS ANGELES	CA	90044	2442	19	06037	33.97458895	-118.2929746	Los Angeles County
21493	Fee-for-Service	1326278490	1326278490	1	8	JANESRI DE SILVA M.D. A PROF	6/8/2017	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	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
21499	Fee-for-Service	1801941471	1801941471	1	1	JIMENEZ-SHEPPARD, CIDA A PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	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
21513	Fee-for-Service	1245314624	1245314624	1	1	JOHL, SUMIT MD	5/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45643	40	Pediatrics	0	In state provider	None	470 DEL NORTE AVE	None	YUBA CITY	CA	95991	4125	51	06101	39.1433712	-121.6203402	Sutter County
21534	Fee-for-Service	1417053729	1417053729	1	1	JANI, ATUL N MD INC	12/10/2008	193400000X	NA	Other	026	PHYSICIANS	72649	None	None	0	In state provider	None	236 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
21591	Fee-for-Service	1518062413	1518062413	1	1	JEFFREY JONES MD	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	509 S BRIGHTLEAF BLVD	None	SMITHFIELD	NC	27577	4076	00	None	35.50358724	-78.34358346	Johnston County
21683	Fee-for-Service	1558551143	1558551143	1	1	JAMWAL, ABHILASHA MD	10/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56052	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
21712	Fee-for-Service	1083173132	1083173132	1	1	JAGGI, AKASH MD	12/16/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	191230	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	675 N 1ST ST	STE 100A	SAN JOSE	CA	95112	5137	43	06085	37.34856453	-121.899953	Santa Clara County
21759	Fee-for-Service	1558670059	1558670059	1	1	JOHNSON, JEREMIAH L PHD	1/30/2017	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
21788	Fee-for-Service	1467535070	1467535070	1	1	JANAPATI, PAVAN K MD	4/22/2013	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
21822	Fee-for-Service	1851307649	1851307649	1	1	JOSHI, RAVI V MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96107	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
21844	Fee-for-Service	1194844597	1194844597	1	1	JESSICA BASA, M.D., INC.	9/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	705 E VIRGINIA WAY	SUITE F	BARSTOW	CA	92311	3978	36	06071	34.88815781	-117.018543	San Bernardino County
21889	Fee-for-Service	1457497331	1457497331	1	1	JEFFERSON ELEMENTARY SD	3/20/2005	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1219 WHISPERING WIND DR	None	TRACY	CA	95377	8269	39	06077	37.70007519	-121.4412605	San Joaquin County
21917	Fee-for-Service	1407819386	1407819386	1	1	JESPERSON, ROBERT C DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1333 N 2ND ST	None	EL CAJON	CA	92021	3434	37	06073	32.813865	-116.935642	San Diego County
21941	Fee-for-Service	1093750655	1093750655	1	1	JACOBS, CAROLYN F PHD	9/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	625 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62998356	-117.0754419	San Diego County
21962	Fee-for-Service	1477575066	1477575066	1	1	JOHN MUIR MED FOUNDATION	3/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	JOHN MUIR PHYSICIAN NETW	2255 YGNACIO VALLEY RD	STE A	WALNUT CREEK	CA	94598	3349	07	06013	37.92242643	-122.0301696	Contra Costa County
21998	Fee-for-Service	1992872816	1992872816	1	1	JACOB, JESSY MD	8/22/1995	207R00000X	NA	Other	026	PHYSICIANS	55673	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
21999	Fee-for-Service	1285831594	1285831594	1	1	JENNIFER ARZOLA, M.D.	1/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7930 FLOYD CURL DR	None	SAN ANTONIO	TX	78229	3925	00	None	29.51157346	-98.57548112	Bexar County
22104	Fee-for-Service	1295067981	1295067981	1	1	JONES, DAVID O MD	4/1/2018	207P00000X	NA	Other	026	PHYSICIANS	153481	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
22107	Fee-for-Service	1154762011	1154762011	1	1	JIREGNA, MAHALET C	1/16/2023	231H00000X	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
22145	Fee-for-Service	1073727558	1073727558	1	2	JB & MM CONSULTING SERVICES	6/6/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	19725 SHERMAN WAY	SUITE 282	WINNETKA	CA	91306	3660	19	06037	34.20117847	-118.563057	Los Angeles County
22248	Fee-for-Service	1477575066	1477575066	1	1	JOHN MUIR MED FOUNDATION	3/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	JOHN MUIR PHYSICIAN NETW	2255 YGNACIO VALLEY RD	STE A	WALNUT CREEK	CA	94598	3349	07	06013	37.92242643	-122.0301696	Contra Costa County
22267	Fee-for-Service	1336192574	1336192574	1	1	JACOBSON, BEN E MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72246	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
22305	Fee-for-Service	1699068387	1699068387	1	1	JAMES W BUCKNER II	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20701 N SCOTTSDALE RD	# 107-601	SCOTTSDALE	AZ	85255	6413	00	None	33.6750627	-111.9253307	Maricopa County
22307	Fee-for-Service	1376566208	1376566208	1	1	JO SHAPIRO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	45 FRANCIS ST	None	BOSTON	MA	02115	6105	00	None	42.335109	-71.1057555	Suffolk County
22346	Fee-for-Service	1649210261	1649210261	1	1	JENSEN, MAUREEN C MD	5/31/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61494	30	Radiology	0	In state provider	None	10111 HOLE AVE	None	RIVERSIDE	CA	92503	3441	33	06065	33.91431544	-117.4585034	Riverside County
22394	Fee-for-Service	1619083979	1619083979	1	1	JONES, REGINALD J	7/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63406	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	SUITE 404	LYNWOOD	CA	90262	3534	19	06037	33.92872742	-118.2006921	Los Angeles County
22442	Fee-for-Service	1023003605	1023003605	1	1	JACKSON, ROBERT J MD	1/29/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	71112	14	Neurological Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
22520	Fee-for-Service	1477612570	1477612570	1	1	JAVAHERIAN, NAVID DAVID M MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100390	08	Family Practice	0	In state provider	None	14600 SHERMAN WAY	STE 300	VAN NUYS	CA	91405	2272	19	06037	34.20025916	-118.4500763	Los Angeles County
22542	Fee-for-Service	1477575066	1477575066	1	1	JOHN MUIR MED FOUNDATION	3/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	JOHN MUIR PHYSICIAN NETW	2255 YGNACIO VALLEY RD	STE A	WALNUT CREEK	CA	94598	3349	07	06013	37.92242643	-122.0301696	Contra Costa County
22573	Fee-for-Service	1205165198	1205165198	1	1	JACOBSEN, CHRISTINE A	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
22605	Fee-for-Service	1922706761	1922706761	1	1	J & J LY, INC.	7/24/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4917 E KINGS CANYON RD	# 102	FRESNO	CA	93727	3996	10	06019	36.73602653	-119.73087	Fresno County
22622	Fee-for-Service	1801357348	1801357348	1	1	JAYMES, TWYLA MD	9/25/2023	207L00000X	NA	Other	026	PHYSICIANS	182047	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
22727	Fee-for-Service	1861625170	1861625170	1	1	JUNG, NICHOLAS G MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107536	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
22759	Fee-for-Service	1275517302	1275517302	1	1	JARDINI, EDWARD P MD	5/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60166	08	Family Practice	0	In state provider	None	1320 LAS TABLAS RD	STE F	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
22776	Fee-for-Service	1689812992	1689812992	1	1	JENNINGS, JANIS LMFT	9/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22 W MICHELTORENA ST.	SUITE A	SANTA BARBARA	CA	93101	1467	42	06083	34.4255722	-119.7090178	Santa Barbara County
22788	Fee-for-Service	1932460839	1932460839	1	1	JIA, XIAOMING MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128028	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
22859	Fee-for-Service	1134612500	1134612500	1	1	JOHNSTON, JILL M	10/9/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
22918	Fee-for-Service	1407170665	1407170665	1	1	JACKSON, SANDRA M	11/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6809 INDIANA AVE	138	RIVERSIDE	CA	92506	9997	33	06065	33.94312844	-117.3918196	Riverside County
22948	Fee-for-Service	1538217567	1538217567	1	1	JAMAL, FAIZI A MD	11/1/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	91207	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1500 E DURATE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
23028	Fee-for-Service	1023196870	1023196870	1	1	JHAVERI, SOHAM DO	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8646	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
23053	Fee-for-Service	1639462450	1639462450	1	1	JOHNSON, EVAN MD	8/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185839	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
23072	Fee-for-Service	1740504356	1740504356	1	1	JAVIEN, JOHN B MD	1/17/2020	207R00000X	NA	Other	026	PHYSICIANS	121471	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	611	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
23196	Fee-for-Service	1689701450	1689701450	1	1	JAIN, SHONUL A MD	4/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94229	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
23203	Fee-for-Service	1346544830	1346544830	1	1	JOHNSON, MARCELLINA NP	12/23/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
23239	Fee-for-Service	1417993528	1417993528	1	1	JOHN, ROY M MD	10/8/2021	207R00000X	NA	Other	026	PHYSICIANS	172396	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23274	Fee-for-Service	1437793999	1437793999	1	1	JANJUGHAZYAN, ANIK	6/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16133 VENTURA	1125	ENCINO	CA	91436	2403	19	06037	34.15656164	-118.4849569	Los Angeles County
23406	Fee-for-Service	1316272875	1316272875	1	1	JOSHUA J KNIGHT	5/21/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2807 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54417815	-122.669649	Multnomah County
23446	Fee-for-Service	1871867135	1871867135	1	1	JAVADI, NADER MD A	1/14/2013	193400000X	NA	Other	026	PHYSICIANS	67700	68	Hematology	0	In state provider	PROFESSIONAL CORPORATION	19231 VICTORY BLVD	STE #103	RESEDA	CA	91335	6308	19	06037	34.18659852	-118.552221	Los Angeles County
23473	Fee-for-Service	1992738306	1992738306	1	1	JAKL, MILES S MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50129	41	Internal Medicine	0	In state provider	None	10515 BALBOA BLVD	STE 240	GRANADA HILLS	CA	91344	6360	19	06037	34.261497	-118.502318	Los Angeles County
23495	Fee-for-Service	1699923847	1699923847	1	1	JESSICA MCGHEE	6/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4444 E 41ST ST	None	TULSA	OK	74135	2527	00	None	36.101988	-95.925141	Tulsa County
23525	Fee-for-Service	1407115389	1407115389	1	1	JEROME, ELIZABETH MD	9/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
23529	Fee-for-Service	1518592914	1518592914	1	1	JESSE WOO MD INC	7/16/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1818 N ORANGE GROVE AVE	None	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
23549	Fee-for-Service	1053852459	1053852459	1	1	JAFARI, NIMA LMFT	12/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43460 RIDGE PARK DR	STE 245	TEMECULA	CA	92590	3619	33	06065	33.49676946	-117.1608841	Riverside County
23574	Fee-for-Service	1871884270	1871884270	1	1	JOHNSON, DAVID C MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142392	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	STE 140	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
23612	Fee-for-Service	1861526881	1861526881	1	1	JONES, HEATHER LMFT	10/15/2020	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
23691	Fee-for-Service	1013204080	1013204080	1	1	JINCY THANKANCHEN	5/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3424 KOSSUTH AVE	None	BRONX	NY	10467	2410	00	None	40.880385	-73.8815355	Bronx County
23708	Fee-for-Service	1639650740	1639650740	1	1	JORGENSEN, URSULA A LMFT	8/19/2021	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
23733	Fee-for-Service	1871867135	1871867135	1	1	JAVADI, NADER MD A	1/14/2013	193400000X	NA	Other	026	PHYSICIANS	67700	78	Neoplastic Diseases/Oncology	0	In state provider	PROFESSIONAL CORPORATION	19231 VICTORY BLVD	STE #103	RESEDA	CA	91335	6308	19	06037	34.18659852	-118.552221	Los Angeles County
23962	Fee-for-Service	1417918145	1417918145	1	1	JABEEN, MUSARET MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3741 W 12600 S	None	RIVERTON	UT	84065	7215	00	None	40.520232	-111.980151	Salt Lake County
24022	Fee-for-Service	1871867135	1871867135	1	1	JAVADI, NADER MD A	1/14/2013	193400000X	NA	Other	026	PHYSICIANS	67700	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	19231 VICTORY BLVD	STE #103	RESEDA	CA	91335	6308	19	06037	34.18659852	-118.552221	Los Angeles County
24127	Fee-for-Service	1346775608	1346775608	1	1	JASICKI, STANTON DO	8/31/2022	207P00000X	NA	Other	026	PHYSICIANS	18673	None	None	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
24187	Fee-for-Service	1942451661	1942451661	1	1	JANDA, HERJAP S MD	6/4/2019	207R00000X	NA	Other	026	PHYSICIANS	145618	41	Internal Medicine	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
24195	Fee-for-Service	1609979483	1609979483	1	1	JAVAGAL, SREEHARI S MD	2/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71212	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
24297	Fee-for-Service	1346222510	1346222510	1	1	JARDULA, MICHAEL F MD	6/3/2019	207R00000X	NA	Other	026	PHYSICIANS	87344	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
24318	Fee-for-Service	1770661308	1770661308	1	1	JAFFE, MARC G MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46300	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
24400	Fee-for-Service	1932249406	1932249406	1	1	JONBEC CARE, INC	11/10/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BLANDFORD HOUSE	13131 6TH PL	UNIT 1	YUCAIPA	CA	92399	2345	36	06071	34.01475809	-117.0624832	San Bernardino County
24430	Fee-for-Service	1386281541	1386281541	1	1	JUAREZ, AMERICA P LCSW	12/17/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
24439	Fee-for-Service	1346747235	1346747235	1	1	JDS CONSULTING, INC.	8/23/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1651 E 4TH ST	120	SANTA ANA	CA	92701	5141	30	06059	33.74814742	-117.8454019	Orange County
24442	Fee-for-Service	1093763781	1093763781	1	1	JACKSON COUNTY MEMORIAL	4/5/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL AUTHORITY	1200 E PECAN ST	None	ALTUS	OK	73521	6141	00	None	34.63529809	-99.31892165	Jackson County
24509	Fee-for-Service	1811298391	1811298391	1	1	JUNG, CHANSUK LCSW	2/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	850 COLORADO BLVD	STE 104	LOS ANGELES	CA	90041	1762	19	06037	34.13949784	-118.1843467	Los Angeles County
24578	Fee-for-Service	1285128827	1285128827	1	1	JONES, TIMOTHY CRNA	12/10/2020	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
24674	Fee-for-Service	1326135153	1326135153	1	1	JOHNSON, SYLVIA A MD	12/23/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60618	40	Pediatrics	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 138	TEMECULA	CA	92591	5211	33	06065	33.50627123	-117.1431728	Riverside County
24677	Fee-for-Service	1366645145	1366645145	1	1	JAMES T WANG MD INC	3/26/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	29833 SANTA MARGARITA PK	SUITE 100	RANCHO SANTA MARG	CA	92688	3619	30	06059	33.63792372	-117.6108629	Orange County
24732	Fee-for-Service	1093763781	1093763781	1	1	JACKSON COUNTY MEMORIAL	4/5/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL AUTHORITY	1200 E PECAN ST	None	ALTUS	OK	73521	6141	00	None	34.63529809	-99.31892165	Jackson County
24765	Fee-for-Service	1629275581	1629275581	1	1	JEWELL, JOSHUA F MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
24768	Fee-for-Service	1104049626	1104049626	1	1	JOHN C FREMONT MED CLN	12/9/2002	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
24794	Fee-for-Service	1326278490	1326278490	1	14	JANESRI DE SILVA M.D. A PROF	2/23/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3524 TORRANCE BLVD	SUITE 101	TORRANCE	CA	90503	4821	19	06037	33.8355	-118.3472955	Los Angeles County
24862	Fee-for-Service	1265293690	1265293690	1	1	JASLEEN SINGH, M.D., P.C.	7/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	264 N HIGHLAND SPRINGS A	D	BANNING	CA	92220	3082	33	06065	33.93063	-116.946864	Riverside County
24888	Fee-for-Service	1235475534	1235475534	1	1	JADROOL LLC	5/24/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	816 E BROADWAY ST	None	GLENDALE	CA	91205	1218	19	06037	34.1462217	-118.2448592	Los Angeles County
24904	Fee-for-Service	1932566288	1932566288	1	1	JORDAN, MICHAEL J NP	8/25/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
24931	Fee-for-Service	1972942126	1972942126	1	1	JUNG, CHRISTINE Y DO	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15568	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
24939	Fee-for-Service	1043406275	1043406275	1	1	JOHNSON, ALEDA MARIE	4/16/2009	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	23885 LAKE VISTA RD	None	MORENO VALLEY	CA	92557	2815	33	06065	33.97301131	-117.2466294	Riverside County
24953	Fee-for-Service	1326278490	1326278490	1	11	JANESRI DE SILVA M.D. A PROF	3/8/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	14426 GILMORE ST	STE B	VAN NUYS	CA	91401	1429	19	06037	34.18761452	-118.4474475	Los Angeles County
25013	Fee-for-Service	1588848915	1588848915	1	1	JONES, JENNIFER M	9/27/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	822 MAHLER RD	None	BURLINGAME	CA	94010	1604	41	06081	37.59743866	-122.3670532	San Mateo County
25053	Fee-for-Service	1629275581	1629275581	1	1	JEWELL, JOSHUA F MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
25097	Fee-for-Service	1235298944	1235298944	1	1	JUNG, EMMANUEL D MD	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80765	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 1000	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
25139	Fee-for-Service	1881161388	1881161388	1	1	JULIAN, JEAZALE A CNP	12/11/2019	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
25150	Fee-for-Service	1073720983	1073720983	1	1	JAMES SCHMIDT MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
25228	Fee-for-Service	1043406275	1043406275	1	1	JOHNSON, ALEDA MARIE	4/16/2009	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	23885 LAKE VISTA RD	None	MORENO VALLEY	CA	92557	2815	33	06065	33.97301131	-117.2466294	Riverside County
25287	Fee-for-Service	1558339747	1558339747	1	1	JOHNSON, ROBERT N MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52144	18	Ophthalmology	0	In state provider	None	1 DANIEL BURNHAM CT	APT 210	SAN FRANCISCO	CA	94109	5460	38	06075	37.78693724	-122.4225429	San Francisco County
25361	Fee-for-Service	1750928438	1750928438	1	1	JONES, JACOB D PHD	1/14/2020	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
25451	Fee-for-Service	1821295585	1821295585	1	1	JOHNSON, ARIKA L A PSYD	8/21/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3420 KENYON ST	None	SAN DIEGO	CA	92110	5001	37	06073	32.74894593	-117.2139252	San Diego County
25493	Fee-for-Service	1871898064	1871898064	1	2	JUDEH, JIHAN V LMFT	10/1/2021	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
25530	Fee-for-Service	1639785421	1639785421	1	1	JUDD, ALEXANDRA E OT	6/1/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25587	Fee-for-Service	1982990669	1982990669	1	1	JENSON, WHITNEY R MD	10/9/2020	2086S0127X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
25614	Fee-for-Service	1295802148	1295802148	1	1	JACOB, PETER J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35470	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
25655	Fee-for-Service	1770998783	1770998783	1	1	JIANG, LAURENCE M MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142126	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE ROAD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
25662	Fee-for-Service	1669046793	1669046793	1	1	JONES, ATHENA PHD	12/10/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	940 S COAST DR STE 225	None	COSTA MESA	CA	92626	7757	30	06059	33.68993791	-117.8953504	Orange County
25717	Fee-for-Service	1508868787	1508868787	1	1	JOO, CHANG S MD	11/30/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	48192	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
25733	Fee-for-Service	1124097779	1124097779	1	1	JOHNSTON, LISA A MD	8/19/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	105006	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
25739	Fee-for-Service	1508911173	1508911173	1	1	J & J ARTIFICIAL LIMB & BRAC	10/24/2005	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	E, LLC	15644 POMERADO RD	STE 103	POWAY	CA	92064	2428	37	06073	32.99717879	-117.0579379	San Diego County
25970	Fee-for-Service	1821841818	1821841818	1	1	JOSEPH H. NGUYEN, O.D., PROF	4/22/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ESSIONAL CORPORATION	1290 E ONTARIO AVE	None	CORONA	CA	92881	3618	33	06065	33.84697297	-117.5405763	Riverside County
26108	Fee-for-Service	1033303060	1033303060	1	1	JONES, DANIELLE J LCSW	5/19/2017	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
26112	Fee-for-Service	1326278490	1326278490	1	6	JANESRI DE SILVA M.D. A PROF	4/21/2014	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	777 TRUMAN STREET	104 & 105	SAN FERNANDO	CA	91340	3383	19	06037	34.2812781	-118.4387659	Los Angeles County
26151	Fee-for-Service	1407019052	1407019052	1	1	JAZAYERI, LILA MD	9/16/2019	208200000X	NA	General Surgery	026	PHYSICIANS	112069	24	Plastic Surgery	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
26198	Fee-for-Service	1568726644	1568726644	1	1	JARADAT, MOHAMMAD M MD	8/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
26205	Fee-for-Service	1366855025	1366855025	1	1	JETHRO MEDICAL	12/8/2014	332BN1400X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2142 N FINE AVE	None	FRESNO	CA	93727	1513	10	06019	36.77016311	-119.7274093	Fresno County
26363	Fee-for-Service	1265726418	1265726418	1	1	JOHNSTON, JESSICA M	2/24/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
26452	Fee-for-Service	1023503992	1023503992	1	1	JUNUS, KEVIN L DO	6/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17816	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
26481	Fee-for-Service	1760536577	1760536577	1	1	JOISHA, AHALYA P MD	3/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107238	38	Geriatrics	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
26486	Fee-for-Service	1063477081	1063477081	1	1	JELODARI, NARGES MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	36718	01	General Practice	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
26507	Fee-for-Service	1811156524	1811156524	2	1	JENYMELS HOME CARE INC	4/23/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	18314 IBEX ST	None	ARTESIA	CA	90701	5757	19	06037	33.86526057	-118.0735248	Los Angeles County
26563	Fee-for-Service	1265936389	1265936389	1	1	JENNIFER MICHAEL MD, A MEDIC	3/28/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	AL CORPORATION	2776 PACIFIC AVENUE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
26743	Fee-for-Service	1619048519	1619048519	1	1	JANCIS, MOLLY O MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66565	66	Emergency Medicine (Urgent Care)	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
26751	Fee-for-Service	1386208791	1386208791	1	1	JACOBS, NATALIA MD	4/17/2024	207R00000X	NA	Other	026	PHYSICIANS	181473	None	None	0	In state provider	None	28400 MCCALL BLVD	None	MENIFEE	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
26777	Fee-for-Service	1063477081	1063477081	1	1	JELODARI, NARGES MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	36718	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
26938	Fee-for-Service	1255725156	1255725156	1	1	JOHNSON, BILLY CNP	7/12/2023	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
26951	Fee-for-Service	1487417556	1487417556	1	1	JONES, ANDREW LMFT	10/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
27010	Fee-for-Service	1063515856	1063515856	1	1	JOHNSON, BETHELEN MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63157	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
27077	Fee-for-Service	1225324379	1225324379	1	1	JENKS, CONNELLY A LCSW	3/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	69018	-	NOT APPLICABLE	0	In state provider	None	13931 VAN NESS AVE	None	GARDENA	CA	90249	2941	19	06037	33.905079	-118.3178875	Los Angeles County
27091	Fee-for-Service	1922273119	1922273119	1	2	JAHANGIR SHARIFI MD, INC.	4/15/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	ISTS	1701 E CESAR E CHAVEZ AV	SUITE 560	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
27112	Fee-for-Service	1336336700	1336336700	1	1	JONG, CHRISTOPHER K MD	4/8/2008	207R00000X	NA	Other	026	PHYSICIANS	94265	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DRIVE	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
27167	Fee-for-Service	1528281680	1528281680	1	1	JAMGOCHYAN, DIANA L	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	110 N LA BREA AVENUE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
27174	Fee-for-Service	1104406842	1104406842	1	1	JURKOSHEK, KATERINA DO	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	23352	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
27200	Fee-for-Service	1346248911	1346248911	1	1	JOYSE G SCHWARTZ	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4085 DE ZAVALA RD	None	SHAVANO PARK	TX	78249	2084	00	None	29.57765867	-98.56374005	Bexar County
27277	Fee-for-Service	1336593037	1336593037	1	1	JAGANNATHAN, SAMANTHA P MD	2/26/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171023	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
27306	Fee-for-Service	1659533347	1659533347	1	1	JI YUAN M.D.	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CENT	None	OMAHA	NE	68198	0001	00	None	0	0	None
27314	Fee-for-Service	1508073511	1508073511	1	1	JELLISON, FORREST C MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98781	34	Urology and Urological Surgery	0	In state provider	None	200 MED PLZ	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
27344	Fee-for-Service	1912534702	1912534702	1	1	JAMES, TAYLOR M MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	183414	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
27399	Fee-for-Service	1023438512	1023438512	1	1	JEAN, SAMANTHA MD	8/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181445	None	None	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
27430	Fee-for-Service	1598182842	1598182842	1	1	JENSEN, JACOB K MD	7/7/2017	207P00000X	NA	Other	026	PHYSICIANS	149863	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
27437	Fee-for-Service	1225135999	1225135999	1	1	JOHNSON, ERIC E MD	1/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38631	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
27452	Fee-for-Service	1881864890	1881864890	1	1	JACOB, JULIE A MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102769	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VAN OWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
27475	Fee-for-Service	1083027312	1083027312	1	1	JIBARA, GHALIB MD	10/28/2021	208800000X	NA	Other	026	PHYSICIANS	173080	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
27576	Fee-for-Service	1841826831	1841826831	1	1	JAIN, SUSANNA K MD	8/8/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187687	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
27624	Fee-for-Service	1457608580	1457608580	3	1	JUST 4 KIDS PEDIATRICS, INC	10/22/2020	152WP0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1433 W. MERCED AVE	SUITE 103	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
27653	Fee-for-Service	1215279526	1215279526	1	1	JHURANI, SONIA MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142983	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
27701	Fee-for-Service	1811067457	1811067457	1	1	JEFFORDS, BRIAN K MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78134	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
27761	Fee-for-Service	1942369533	1942369533	1	1	JAN, AMY Y MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
27819	Fee-for-Service	1225221740	1225221740	1	1	JENKINS, PRUDENCE A 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
27827	Fee-for-Service	1619548542	1619548542	1	1	JOURNEY COUNSELING CENTER, I	9/11/2023	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NC	44709 DATE AVE	None	LANCASTER	CA	93534	3101	19	06037	34.69471258	-118.1403055	Los Angeles County
27841	Fee-for-Service	1679685440	1679685440	1	2	JOHNSON, ALAN M MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87257	41	Internal Medicine	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
27853	Fee-for-Service	1811915481	1811915481	1	2	JEN, WENCHENG MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	70481	41	Internal Medicine	0	In state provider	None	416 W LAS TUNAS DR	STE 305	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
28015	Fee-for-Service	1083956767	1083956767	1	1	JASTI, SIVA P MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136101	30	Radiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
28123	Fee-for-Service	1902848914	1902848914	1	1	JOYCE, PETER W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27223	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
28217	Fee-for-Service	1902558182	1902558182	1	1	JAN, SARA N	4/4/2022	2251X0800X	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
28261	Fee-for-Service	1689621005	1689621005	1	1	JONES, JOANNE CNP	4/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
28269	Fee-for-Service	1720465933	1720465933	1	1	JAKE W. SHARP	10/21/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	890 OAK ST SE	None	SALEM	OR	97301	3905	00	None	44.932887	-123.0341175	Marion County
28315	Fee-for-Service	1063781797	1063781797	1	1	JASON PERNELL HEAVENS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2050 W SOUTHERN AVE	None	APACHE JCT	AZ	85120	7305	00	None	33.39423	-111.56679	Pinal County
28357	Fee-for-Service	1215053335	1215053335	1	1	JENNELLE, RICHARD S MD	9/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87183	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
28424	Fee-for-Service	1639109101	1639109101	1	1	JOSEPH, BOBAN A MD	6/30/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32523	18	Ophthalmology	0	In state provider	None	50 ALESSANDRO PL	STE 210	PASADENA	CA	91105	4005	19	06037	34.13101049	-118.151532	Los Angeles County
28478	Fee-for-Service	1205914041	1205914041	1	1	JOHNSON, NICOLE C MD	4/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76686	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
28540	Fee-for-Service	1376709352	1376709352	1	1	JAMES G. KALKANIS, MD A MEDI	6/9/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	CAL CORPORATION	341 MAGNOLIA AVE	SUITE 206	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
28731	Fee-for-Service	1396893251	1396893251	1	1	JAFFE, MICHAEL S DO	7/31/1995	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	6517	25	Physical Medicine and Rehabilitation	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
28747	Fee-for-Service	1760853022	1760853022	1	1	JOHNSON, WILLISHIA LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
28802	Fee-for-Service	1669529764	1669529764	1	1	JOHNSON, RODNEY C OD	12/11/2002	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3405 MARRON RD	None	OCEANSIDE	CA	92056	4673	37	06073	33.17785335	-117.2977901	San Diego County
28822	Fee-for-Service	1790715860	1790715860	1	1	JI, SEN MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72488	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
28891	Fee-for-Service	1922428119	1922428119	1	1	JOHL, MICHAEL M MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140871	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
28916	Fee-for-Service	1811917362	1811917362	1	1	JOHN H FISHER	9/5/1990	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1007 W AVENUE M14	STE B	PALMDALE	CA	93551	1443	19	06037	34.63305153	-118.148193	Los Angeles County
28945	Fee-for-Service	1093096919	1093096919	1	1	JAINI, SRIDIVYA MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130261	None	None	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93729	8949	10	06019	36.74333844	-119.7831874	Fresno County
28948	Fee-for-Service	1962707265	1962707265	1	1	JAIN, ANJALI MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113442	67	Endocrinology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
28949	Fee-for-Service	1285740845	1285740845	1	1	JASON G BECHARD 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 LN	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
29034	Fee-for-Service	1154529063	1154529063	1	1	JANKOSKI, JOHN J	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
29045	Fee-for-Service	1841278967	1841278967	1	1	JUMAO-AS, ASELA P MD	4/12/2006	2084N0400X	NA	Neurology	026	PHYSICIANS	43374	13	Neurology (M.D. only)	0	In state provider	None	25 N BURGAN AVE	None	CLOVIS	CA	93611	6133	10	06019	36.83110497	-119.678103	Fresno County
29190	Fee-for-Service	1306970819	1306970819	1	1	JONES, MARY ELLEN T CCC-SLP	8/16/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
29203	Fee-for-Service	1356598189	1356598189	1	1	JOHNSTON, JEFFREY S MD	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121896	05	Anesthesiology	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
29212	Fee-for-Service	1912226176	1912226176	1	1	JUAREZ, MARIANA Y LCSW	1/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7600 OLD DOMINION CT	None	APTOS	CA	95003	3821	44	06087	36.97913818	-121.9099818	Santa Cruz County
29267	Fee-for-Service	1760880041	1760880041	1	1	JONES, ANNA A	2/17/2017	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
29394	Fee-for-Service	1083792832	1083792832	1	1	JUNG, ALAN C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83974	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
29447	Fee-for-Service	1467847293	1467847293	1	1	JIMENEZ BACARDI, ADRIA MD	8/21/2019	208M00000X	NA	Other	026	PHYSICIANS	161861	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
29455	Fee-for-Service	1043578974	1043578974	1	1	JAVED, OMAIR M MD	3/18/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	152613	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
29467	Fee-for-Service	1174936132	1174936132	1	1	JAGADISH, ABANTHI MD	3/10/2018	390200000X	NA	Other	026	PHYSICIANS	152144	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
29474	Fee-for-Service	1114799921	1114799921	1	1	JAVIER, AMERY	12/15/2023	225XP0200X	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
29521	Fee-for-Service	1902855232	1902855232	1	1	JALALI, ZIBA MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82913	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
29526	Fee-for-Service	1740423128	1740423128	1	1	JUMAMIL, SUZETTE L MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106717	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
29565	Fee-for-Service	1912918772	1912918772	1	1	JOHNSON, ANTHONY 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	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
29617	Fee-for-Service	1932116977	1932116977	1	1	JENNIFER JERNIGAN MD	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
29623	Fee-for-Service	1568108744	1568108744	1	1	JOHNSON, ALEXANDER M PSYD	5/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2491 ALLUVIAL AVE	400	CLOVIS	CA	93611	9587	10	06019	36.84477477	-119.6688867	Fresno County
29683	Fee-for-Service	1528060449	1528060449	1	1	JOHNSON, JAMLIK MD	12/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92887	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
29692	Fee-for-Service	1659786507	1659786507	1	1	JUNGE, JASMINE S OD	8/11/2014	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
29704	Fee-for-Service	1154363778	1154363778	1	1	JACOBY, VANESSA L MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83634	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
29717	Fee-for-Service	1801812904	1801812904	1	1	JACOBSON, J PAUL MD	2/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67757	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
29809	Fee-for-Service	1902855232	1902855232	1	1	JALALI, ZIBA MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82913	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
29851	Fee-for-Service	1073639001	1073639001	1	1	JONES, MARK ALLEN	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C/O SEARS OPTICAL	2600 COUNTY E MALL	None	ANTIOCH	CA	94509	3173	07	06013	0	0	None
29916	Fee-for-Service	1366098006	1366098006	1	1	JAYMES, HALLE CCC-SLP	10/18/2023	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11870 PIERCE STREET	SUITE 150	RIVERSIDE	CA	92505	4402	33	06065	33.90095662	-117.4936969	Riverside County
30068	Fee-for-Service	1659132520	1659132520	1	1	JUSTYN'S CORNER CHILD AND FA	1/18/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MILY COUNSELING CENTER,	6080 CENTER DR	STE 686	LOS ANGELES	CA	90045	9205	19	06037	33.97675505	-118.391083	Los Angeles County
30196	Fee-for-Service	1427342369	1427342369	1	1	JOHNSON, JANET L LMFT	7/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6244 EL CAJON BLVD	3	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
30211	Fee-for-Service	1891746483	1891746483	1	1	JOHN TERRANCE KENNY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	910 WALLACE AVE	None	LEITCHFIELD	KY	42754	2414	00	None	37.47279163	-86.28675735	Grayson County
30231	Fee-for-Service	1891855896	1891855896	1	1	JOHN STRAYER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EVERGREEN MEDICAL CENTER	12040 NE 128TH ST	None	KIRKLAND	WA	98034	3013	00	None	47.71493427	-122.1792761	King County
30252	Fee-for-Service	1770789661	1770789661	1	1	JACOBSEN, PAUL F MD INC	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	33336	04	Otology, Laryngology, Rhinology	0	In state provider	None	6512 PAINTER AVE	None	WHITTIER	CA	90601	4518	19	06037	33.98233002	-118.0326391	Los Angeles County
30322	Fee-for-Service	1962034496	1962034496	1	1	JACKSON RIVER HOLDINGS LLC	3/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	752 HOLMES ST	None	LIVERMORE	CA	94550	4229	01	06001	37.67334983	-121.7802728	Alameda County
30357	Fee-for-Service	1962588814	1962588814	1	1	JONES, ANNETTE MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70927	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
30389	Fee-for-Service	1952443913	1952443913	1	1	JACOBSON, MARY T MD	6/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
30432	Fee-for-Service	1457068389	1457068389	1	1	JUSTICE, MELANIE R LMFT	10/24/2023	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
30586	Fee-for-Service	1629211669	1629211669	1	1	JAMEHDOR, REZA MD	12/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106792	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
30619	Fee-for-Service	1841865268	1841865268	1	1	JANNISSE, TIMOTHY P PT	8/24/2021	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
30650	Fee-for-Service	1902858483	1902858483	1	1	JAEGER, MARCELLA M MD	4/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87379	08	Family Practice	0	In state provider	None	4062 FLYING C RD	STE 41	CAMERON PARK	CA	95682	9664	09	06017	38.65476716	-120.9977643	El Dorado County
30824	Fee-for-Service	1881446243	1881446243	1	1	JCL INVESTMENTS	2/4/2025	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	& REHABILITATION	318 LINCOLN WAY	SUITE A, B, C, D	AUBURN	CA	95603	4380	31	06061	38.90660653	-121.0664037	Placer County
30829	Fee-for-Service	1669784864	1669784864	1	1	JEREMY CHILD M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
30894	Fee-for-Service	1912319237	1912319237	1	1	JONES, GABRIELLE V H PHD	7/24/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
30960	Fee-for-Service	1598883480	1598883480	1	1	JENNIFER TAYLOR MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
31024	Fee-for-Service	1770911745	1770911745	1	1	JORDAN, LYNN NP	7/7/2023	163W00000X	NA	Other	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
31026	Fee-for-Service	1518027788	1518027788	1	1	JOHNSON, TRACY CRNA	7/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
31045	Fee-for-Service	1689649469	1689649469	1	1	JEFFERSON, MICHAEL K MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	68903	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
31046	Fee-for-Service	1821617887	1821617887	1	1	JANETTE, MEGHAN G MD	4/8/2024	2279E0002X	NA	Other	026	PHYSICIANS	184950	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
31109	Fee-for-Service	1891182911	1891182911	1	1	JESPERSEN NIZAMIC, TIANA MD	7/1/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	155605	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
31120	Fee-for-Service	1669784864	1669784864	1	2	JEREMY CHILD 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	800 W BELT LINE RD	None	DESOTO	TX	75115	4907	00	None	32.58968548	-96.8758875	Dallas County
31154	Fee-for-Service	1386035939	1386035939	1	1	JURGENS, KATIE LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
31193	Fee-for-Service	1154374593	1154374593	1	1	JOHN H REED	11/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
31239	Fee-for-Service	1164498499	1164498499	1	1	JASON ROLAND WOLLMUTH, 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	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
31279	Fee-for-Service	1821550955	1821550955	1	1	JACOBS, ASAF Y MD	6/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	186324	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
31325	Fee-for-Service	1710450457	1710450457	1	1	JACKSON, TANDREA CNP	12/8/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
31326	Fee-for-Service	1780950147	1780950147	1	1	JONATHAN SCHMIDT	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9660 SOUTH 1300 EAST	None	SANDY	UT	84094	5555	00	None	40.57617253	-111.8531739	Salt Lake County
31365	Fee-for-Service	1669244786	1669244786	1	1	JONATHAN MAREHBIAN MEDICAL C	12/9/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	ORPORATION	9763 W PICO BLVD	STE 200	LOS ANGELES	CA	90035	4749	19	06037	34.05426203	-118.401426	Los Angeles County
31383	Fee-for-Service	1558627893	1558627893	1	1	JOHNSTON, LILY E MD	9/24/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	172653	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
31398	Fee-for-Service	1891182911	1891182911	1	1	JESPERSEN NIZAMIC, TIANA MD	7/1/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	155605	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
31404	Fee-for-Service	1619239308	1619239308	1	1	JOSEPH TALREJA, MAIRIN MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142295	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
31438	Fee-for-Service	1972560902	1972560902	1	1	JOHNS, JULIE	11/27/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
31505	Fee-for-Service	1851879316	1851879316	1	1	JORDAN, TAYLOR CRNA	6/25/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	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
31591	Fee-for-Service	1093730061	1093730061	1	1	JESSE, DAVID F MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39932	08	Family Practice	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
31808	Fee-for-Service	1265058028	1265058028	1	1	JOHNSON, BEVERLY A LCSW	10/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR.,	STE. C	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
31825	Fee-for-Service	1013677269	1013677269	1	1	JOSEPH, FEMILA B	8/21/2024	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
31878	Fee-for-Service	1063943967	1063943967	1	1	JIN, ROWEN O MD	8/22/2020	207P00000X	NA	Other	026	PHYSICIANS	158016	None	None	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
31879	Fee-for-Service	1558534370	1558534370	1	1	JONES, VERONICA C MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137824	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
31899	Fee-for-Service	1093730061	1093730061	1	1	JESSE, DAVID F MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
31905	Fee-for-Service	1427081249	1427081249	1	1	JOSEPH P. NESSLER M.D.	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 CONNECTICUT AVE S	None	SARTELL	MN	56377	2554	00	None	45.59432076	-94.20160002	Stearns County
31951	Fee-for-Service	1881796357	1881796357	1	1	JUJARE, VIJAYA MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73112	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
31982	Fee-for-Service	1811332877	1811332877	1	1	JU, SE YOUNG MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139045	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
32003	Fee-for-Service	1366433740	1366433740	1	1	JOSEPH SUTCLIFFE,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	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
32047	Fee-for-Service	1801246947	1801246947	1	1	JACOB, DAISEY T AU	1/25/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
32073	Fee-for-Service	1093058604	1093058604	1	1	JACOBS, DANIEL L DO	11/1/2021	207LP2900X	NA	Other	026	PHYSICIANS	18850	None	None	0	In state provider	None	5120 MANZANITA AVENUE	SUITE 105	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
32125	Fee-for-Service	1629171400	1629171400	1	1	JAUREGUI, PATRICA R MD	9/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79144	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
32149	Fee-for-Service	1275605016	1275605016	1	1	JEWELL, MEREDITH G MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77493	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
32166	Fee-for-Service	1558534370	1558534370	1	1	JONES, VERONICA C MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137824	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
32168	Fee-for-Service	1093730061	1093730061	1	1	JESSE, DAVID F MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39932	01	General Practice	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
32230	Fee-for-Service	1568162055	1568162055	1	1	JOHNSON, DENISE	4/6/2023	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
32275	Fee-for-Service	1033773668	1033773668	1	1	JALEEL, MEDIHA S MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	181223	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
32284	Fee-for-Service	1750324349	1750324349	1	1	JOSEPH, ROBERT H MD	12/27/2007	174400000X	NA	Other	026	PHYSICIANS	21058	41	Internal Medicine	0	In state provider	None	1240 S WESTLAKE BLVD	STE 117	WESTLAKE VILLAGE	CA	91361	1978	56	06111	34.14966879	-118.8378084	Ventura County
32356	Fee-for-Service	1265843437	1265843437	1	1	JACKSON, ROBERT J MD	8/6/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	155009	None	None	0	In state provider	None	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	19	06037	34.12873587	-118.18774	Los Angeles County
32368	Fee-for-Service	1710068952	1710068952	1	1	JACOBSON, JON A MD	12/5/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80763	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
32402	Fee-for-Service	1285947200	1285947200	1	1	JORDAN, JENNIFER M B PHD	8/17/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
32466	Fee-for-Service	1639371719	1639371719	1	1	JI, HANLEE P MD	11/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75926	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32534	Fee-for-Service	1306952957	1306952957	1	2	JONG LIU	7/28/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 HOSPITAL PL	None	SOLDOTNA	AK	99669	7559	00	None	60.493731	-151.077745	Kenai Peninsula Borough
32581	Fee-for-Service	1386781805	1386781805	1	1	JOHNSON, SANDY L CRNA	10/31/1994	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
32596	Fee-for-Service	1619110152	1619110152	1	1	JOHN WOODS	8/30/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	815 S PINE STREET	None	VIVIAN	LA	71082	3314	00	None	32.8635682	-93.98775781	Caddo Parish
32670	Fee-for-Service	1144240110	1144240110	1	1	JACOBSON, JOHN D INC	1/19/1988	207L00000X	NA	Other	026	PHYSICIANS	33299	05	Anesthesiology	0	In state provider	EISENHOWER MEM HOSP	69844 HIGHWAY 111	STE E	RANCHO MIRAGE	CA	92270	2849	33	06065	33.76988393	-116.4463473	Riverside County
32749	Fee-for-Service	1205948064	1205948064	1	1	JOHNSON, LINDA R 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	0000	00	None	45.789696	-108.5132835	Yellowstone County
32755	Fee-for-Service	1639371719	1639371719	1	1	JI, HANLEE P MD	11/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75926	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32756	Fee-for-Service	1093718728	1093718728	1	1	JOHN T MATHER MEM HOSP	3/6/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	75 N COUNTRY RD	None	PRT JEFFERSON	NY	11777	2119	00	None	40.939254	-73.054386	Suffolk County
32873	Fee-for-Service	1760491500	1760491500	1	1	JAIN, MAMTA MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89764	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
32876	Fee-for-Service	1801512660	1801512660	1	1	JONES, KYLEE S LCSW	3/1/2023	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
32877	Fee-for-Service	1366646978	1366646978	1	1	JUNG, THELMA V LCSW	3/11/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
32892	Fee-for-Service	1801863022	1801863022	1	1	JEAN-MARIE R EBRAHIMI MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 NORTH SMITH AVE	None	ST PAUL	MN	55102	2346	00	None	44.94251219	-93.1074995	Ramsey County
32897	Fee-for-Service	1831106665	1831106665	1	1	JAYASINGHE, WALTER MD	2/20/1986	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	26210	30	Radiology	0	In state provider	None	345 E TACHEVAH DR	STE 1	PALM SPRINGS	CA	92262	5742	33	06065	33.83752548	-116.543934	Riverside County
32922	Fee-for-Service	1659452092	1659452092	1	1	JACKSON, ROY H MD INC	11/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP	65 N MADISON AVE	STE 200	PASADENA	CA	91101	2035	19	06037	34.14705803	-118.1384317	Los Angeles County
32931	Fee-for-Service	1770875676	1770875676	1	1	JERATH, VANDANA MD	12/13/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	125869	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
32935	Fee-for-Service	1558438911	1558438911	1	1	JOSEPHS, MARLENE K LMFT	7/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11500 OLYMPIC BLVD	STE 400	LOS ANGELES	CA	90064	1525	19	06037	34.03617514	-118.4445122	Los Angeles County
32945	Fee-for-Service	1063170603	1063170603	1	1	JAIN, ALEXANDRA F PT	2/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
32959	Fee-for-Service	1164737607	1164737607	1	1	JONES, DESIREE T LMFT	9/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
33043	Fee-for-Service	1093718728	1093718728	1	1	JOHN T MATHER MEM HOSP	3/6/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	75 N COUNTRY RD	None	PRT JEFFERSON	NY	11777	2119	00	None	40.939254	-73.054386	Suffolk County
33069	Fee-for-Service	1255569786	1255569786	1	1	JOHN, KATRINA L MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127303	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
33087	Fee-for-Service	1255564266	1255564266	1	1	JENSEN, ERIK MD	8/7/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
33136	Fee-for-Service	1508681529	1508681529	1	1	JOHNSON, LEAH A	2/18/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
33179	Fee-for-Service	1134431505	1134431505	1	1	JEREMY MICHAEL COPE	9/11/2018	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
33206	Fee-for-Service	1730260407	1730260407	1	1	JORDAN PHYSICAL THERAPY	3/22/2011	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CENTER, INC	42080 STATE ST	None	PALM DESERT	CA	92211	5173	33	06065	33.742773	-116.3536445	Riverside County
33284	Fee-for-Service	1043730377	1043730377	1	1	JEFFERSON SHIELDS, MONIK	7/7/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	44335 46TH ST W	None	LANCASTER	CA	93536	7111	19	06037	34.68852427	-118.2129654	Los Angeles County
33291	Fee-for-Service	1770314205	1770314205	1	1	JEFFERSON, WENDY	12/19/2024	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
33385	Fee-for-Service	1770879223	1770879223	1	1	JANI, ASHISH H	11/7/2018	2085R0001X	NA	Other	026	PHYSICIANS	155709	30	Radiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
33424	Fee-for-Service	1114099942	1114099942	1	1	JIMENEZ, CESAR A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45665	None	None	0	In state provider	None	2550 E AMAR RD	STE A2	WEST COVINA	CA	91792	2231	19	06037	34.02732265	-117.8963899	Los Angeles County
33425	Fee-for-Service	1083016091	1083016091	1	1	JACQUES, LINE MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131709	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
33507	Fee-for-Service	1598077125	1598077125	1	1	JOSON, TANNIA H MD	7/18/2019	207R00000X	NA	Other	026	PHYSICIANS	160577	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
33575	Fee-for-Service	1043730377	1043730377	1	1	JEFFERSON SHIELDS, MONIK	7/7/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	44335 46TH ST W	None	LANCASTER	CA	93536	7111	19	06037	34.68852427	-118.2129654	Los Angeles County
33599	Fee-for-Service	1457385916	1457385916	1	1	JOHNSON, MARY A	12/3/2013	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3475 BURROWS AVE	None	WEST SACRAMENTO	CA	95619	9775	57	06113	38.51183498	-121.5714665	Yolo County
33600	Fee-for-Service	1023218419	1023218419	1	1	JIMENEZ, GLORIA P MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99553	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
33618	Fee-for-Service	1013180348	1013180348	1	1	JOHNSON, BERNADETE K MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
33647	Fee-for-Service	1114665882	1114665882	1	1	JOO, HANNAH LMFT	6/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
33655	Fee-for-Service	1306895016	1306895016	1	1	JANET M CEGNAR, MD	10/14/2012	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
33659	Fee-for-Service	1124268511	1124268511	1	1	JINDIA, ANJALI R MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106221	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
33676	Fee-for-Service	1508853243	1508853243	1	1	JANTZ, RICHARD 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	9395 CROWN CREST BLVD	None	PARKER	CO	80138	8573	00	None	39.5497445	-104.7700003	Douglas County
33689	Fee-for-Service	1265429310	1265429310	1	1	JANN, BRADLEY G DPM	5/18/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1375 S ELISEO DR	STE F	GREENBRAE	CA	94904	2013	21	06041	37.94506413	-122.5373483	Marin County
33738	Fee-for-Service	1679505093	1679505093	1	1	JOSEPH MAYLAND, M.D.	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 BECKER AVE SW	None	WILLMAR	MN	56201	3302	00	None	45.1205233	-95.04619753	Kandiyohi County
33760	Fee-for-Service	1275837205	1275837205	1	1	JOHANNES, JIMMY MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119213	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
33764	Fee-for-Service	1942467303	1942467303	1	1	JONES, PRISCILLA A LCSW	11/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3946 NORWOOD AVE	None	SACRAMENTO	CA	95838	3300	34	06067	38.639952	-121.456359	Sacramento County
33785	Fee-for-Service	1245438910	1245438910	1	1	JAFARI, SHAHNAZ NP	8/18/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	121 S GLENOAKS BLVD	SUITE 3	BURBANK	CA	91502	1315	19	06037	34.18291031	-118.3058877	Los Angeles County
33907	Fee-for-Service	1013180348	1013180348	1	1	JOHNSON, BERNADETE K MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
33913	Fee-for-Service	1407102031	1407102031	1	1	JEE, AGNES C MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120459	40	Pediatrics	0	In state provider	None	301 HUNTINGTON DRIVE	SUITE 320	ARCADIA	CA	91007	1500	19	06037	34.13481053	-118.0425638	Los Angeles County
34019	Fee-for-Service	1992913107	1992913107	1	2	JOYCE MARIE HOMES INC	2/8/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2839 S HOLT AVE	None	LOS ANGELES	CA	90034	2510	19	06037	34.03402823	-118.3835668	Los Angeles County
34089	Fee-for-Service	1619047362	1619047362	1	1	JONATHAN C BOWMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KANE COUNTY HOSPITAL	355 N MAIN ST	None	KANAB	UT	84741	0000	00	None	37.054485	-112.5286185	Kane County
34107	Fee-for-Service	1487828802	1487828802	1	1	JAMES, ERIN MD	5/13/2024	207L00000X	NA	Other	026	PHYSICIANS	72455	05	Anesthesiology	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
34198	Fee-for-Service	1508177163	1508177163	1	1	JOHNSON, MARY ANN MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113258	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
34243	Fee-for-Service	1215157326	1215157326	1	1	JEFFRIES ORTHOPAEDIC INC	2/8/2015	332BC3200X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	JEFFRIES ORTHOPAEDIC CO	2300 S HOPE ST	STE 200	LOS ANGELES	CA	90007	2674	19	06037	34.02884801	-118.2723971	Los Angeles County
34337	Fee-for-Service	1881753416	1881753416	1	1	JUHN, JENNIFER MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81019	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
34382	Fee-for-Service	1780260505	1780260505	1	1	JURGENSEN, TARYN MD	6/21/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	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
34493	Fee-for-Service	1043462369	1043462369	1	1	JOINES, MELISSA M MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99312	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
34495	Fee-for-Service	1366479941	1366479941	1	1	JOLIN, PATRICK MD	12/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74492	08	Family Practice	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
34508	Fee-for-Service	1316121304	1316121304	1	1	JAIN, SEEMA MD	1/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	82613	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
34537	Fee-for-Service	1578537460	1578537460	1	1	JEFFREY TIONGSON MD	6/5/2016	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
34580	Fee-for-Service	1356961189	1356961189	1	1	JOAQUIN GALVAN CRNA, A PROFE	4/30/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	SSIONAL NURSING CORPORAT	500 HOSPITAL	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
34603	Fee-for-Service	1184669178	1184669178	1	1	JACOBY, IRVING MD	9/30/1983	207P00000X	NA	Other	026	PHYSICIANS	53173	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
34680	Fee-for-Service	1598415069	1598415069	1	1	JOHNSON, AMY LMFT	6/28/2024	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
34685	Fee-for-Service	1255961132	1255961132	1	1	JORDAN, RYAN LPCC	11/22/2024	106H00000X	NA	Mental Health Outpatient Services	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
34736	Fee-for-Service	1790908788	1790908788	1	1	JACKA, KAREN A LCSW	8/31/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	404 W PINE ST	STE 1	LODI	CA	95240	2048	39	06077	38.13437954	-121.2780387	San Joaquin County
34738	Fee-for-Service	1558005355	1558005355	1	1	JACOB A SPENCER DO INC	8/8/2023	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	36953 COOK ST	STE 101	PALM DESERT	CA	92211	6083	33	06065	33.77921935	-116.3558752	Riverside County
34760	Fee-for-Service	1588772982	1588772982	1	1	JACK HEASLET CHIROPRACTIC IN	3/30/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	502 SPRING STREET	None	PASO ROBLES	CA	93446	3169	40	06079	35.61968517	-120.6907863	San Luis Obispo County
34778	Fee-for-Service	1265449284	1265449284	1	1	JONES,ERIC MD	3/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1040 NW 22ND AVE	STE 168	PORTLAND	OR	97210	0000	00	None	45.53022301	-122.6965631	Multnomah County
34893	Fee-for-Service	1619102837	1619102837	1	1	JECMENICA, MLADEN MD	8/18/2021	207R00000X	NA	Other	026	PHYSICIANS	172173	None	None	0	In state provider	None	2097 COMPTON AVE	BLDG 1, SUITE 103	CORONA	CA	92881	7282	33	06065	33.847776	-117.536173	Riverside County
35039	Fee-for-Service	1194914929	1194914929	2	1	JOWERS, CASEY T MD	12/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 WEST 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
35057	Fee-for-Service	1548270564	1548270564	1	1	JAEGER, STEVEN M MD	4/3/1989	207P00000X	NA	Other	026	PHYSICIANS	65387	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
35124	Fee-for-Service	1114929437	1114929437	1	1	JACKSONS MED SVCS & EQUI	11/3/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	JACKSON, ANDRE W	2930B HILLTOP MALL RD	None	RICHMOND	CA	94806	1902	07	06013	37.9784557	-122.3306995	Contra Costa County
35143	Fee-for-Service	1871634451	1871634451	1	1	JONBEC CARE, INC	1/31/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12000 PEACHTREE LANE	UNIT 1	YUCAIPA	CA	92399	2703	36	06071	34.03664736	-117.0557226	San Bernardino County
35201	Fee-for-Service	1972864544	1972864544	1	1	JOUNG, DAVID MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129377	40	Pediatrics	0	In state provider	None	4440 BROCKTON AVE	SUITE 420	RIVERSIDE	CA	92501	4068	33	06065	33.97764104	-117.3838896	Riverside County
35204	Fee-for-Service	1194751123	1194751123	1	1	JAFFE, HARVEY J MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66040	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
35498	Fee-for-Service	1437121233	1437121233	1	1	JAIN, MANJULA MD	6/8/2018	207R00000X	NA	Other	026	PHYSICIANS	53512	41	Internal Medicine	0	In state provider	None	2211 W MAGNOLIA BLVD	SUITE 290	BURBANK	CA	91506	1773	19	06037	34.1728873	-118.3320905	Los Angeles County
35535	Fee-for-Service	1255809372	1255809372	1	1	JACKSON, EMMA J	3/6/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33048 CANOPY LN	None	LAKE ELSINORE	CA	92532	2535	33	06065	33.65814171	-117.2497686	Riverside County
35568	Fee-for-Service	1578705638	1578705638	1	1	JOHNSON, CHERYL A LMFT	10/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18663 VENTURA BLVD	STE 225	TARZANA	CA	91356	4162	19	06037	34.17051848	-118.5402557	Los Angeles County
35621	Fee-for-Service	1336163906	1336163906	1	1	JENNIFER CHAO	4/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	451 CLARKSON AVE	None	BROOKLYN	NY	11203	2054	00	None	40.656258	-73.9446165	Kings County
35633	Fee-for-Service	1437299450	1437299450	1	1	JOHNSTON, DAVID A	11/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	517 3RD ST	STE 40	EUREKA	CA	95501	5105	12	06023	40.80367671	-124.166036	Humboldt County
35741	Fee-for-Service	1376718890	1376718890	1	1	JONES, DANIEL S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102945	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	SAN DIEGO	CA	92024	5412	37	06073	33.03623896	-117.2837308	San Diego
35747	Fee-for-Service	1487785580	1487785580	2	1	JLM PHARMACY INC	11/21/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1687 ERRINGER RD	#101	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
35775	Fee-for-Service	1003012246	1003012246	1	1	JONES, RYAN M DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	840 W OLIVE AVE	STE A	MERCED	CA	95348	2421	24	06047	37.31844909	-120.4830328	Merced County
35808	Fee-for-Service	1124107511	1124107511	1	1	JAKOBSEN, JOELLE L MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63992	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
35822	Fee-for-Service	1255809372	1255809372	1	1	JACKSON, EMMA J	3/6/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33048 CANOPY LN	None	LAKE ELSINORE	CA	92532	2535	33	06065	33.65814171	-117.2497686	Riverside County
35900	Fee-for-Service	1396880415	1396880415	1	1	JEWETT, KELSEY H OD	2/20/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INDEPENDENT OPTOMETRY	3330 D-2 CHURN CREEK RD	None	REDDING	CA	96002	0000	45	06089	40.55890497	-122.3530646	Shasta County
35956	Fee-for-Service	1972215622	1972215622	1	1	JULIA K SHAVER APRN-CNP	11/25/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
35957	Fee-for-Service	1841360260	1841360260	1	1	JOHNSON, CHERLIN E MD	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85541	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
35975	Fee-for-Service	1326278490	1326278490	1	16	JANESRI DE SILVA M.D. A PROF	7/26/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	20655 SOLEDAD CANYON RD	SUITE 25	CANYON COUNTRY	CA	91351	2434	19	06037	34.42093555	-118.4977343	Los Angeles County
36092	Fee-for-Service	1609219682	1609219682	1	1	JOHNSON, ANNELYSSA N MD	8/17/2017	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
36245	Fee-for-Service	1477584993	1477584993	1	1	JFK MEMORIAL HOSPITAL INC	5/31/2001	261QA1903X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
36292	Fee-for-Service	1023048295	1023048295	1	1	JEFFREY PINE HOLDINGS	6/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE CENTER	622 S ANZA ST	None	EL CAJON	CA	92020	6602	37	06073	32.789403	-116.9482165	San Diego County
36464	Fee-for-Service	1487146734	1487146734	1	1	JAHAN, MANSURA MD	12/10/2021	207R00000X	NA	Other	026	PHYSICIANS	174084	None	None	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
36531	Fee-for-Service	1477584993	1477584993	1	1	JFK MEMORIAL HOSPITAL INC	5/31/2001	282NC2000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
36548	Fee-for-Service	1720314107	1720314107	1	1	JABBARI, SIAVASH MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99269	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
36567	Fee-for-Service	1790148583	1790148583	1	1	JAMES, KENNETH B MD	3/26/2025	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
36689	Fee-for-Service	1366513285	1366513285	1	1	JAVIER, ROWENA G MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88423	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
36712	Fee-for-Service	1497857023	1497857023	1	1	JANSSEN, MATTHEW U MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86129	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
36780	Fee-for-Service	1942478318	1942478318	1	1	JONATHAN FRIEDMAN, 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
36785	Fee-for-Service	1851635148	1851635148	1	1	JOHNSTON, JENNY LAC	11/8/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY DR	SUITE 180	SCOTTS VALLEY	CA	95066	3452	44	06087	37.06204883	-122.0069319	Santa Cruz County
36786	Fee-for-Service	1336428499	1336428499	1	1	JAYAMAHA, DHARSHINIE MD	6/18/2024	2080P0204X	NA	Other	026	PHYSICIANS	192188	30	Radiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
36833	Fee-for-Service	1720314107	1720314107	1	1	JABBARI, SIAVASH MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99269	30	Radiology	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
36846	Fee-for-Service	1831321223	1831321223	1	1	JUNG, SUSAN H MD	11/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127113	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
36974	Fee-for-Service	1346581535	1346581535	1	1	JANG, JESSICA S NP	10/5/2018	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
36985	Fee-for-Service	1164437521	1164437521	1	2	JAFAR, SYED H MD	5/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53226	36	Psychiatry	0	In state provider	None	7850 VISTA HILL	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
36996	Fee-for-Service	1588907174	1588907174	1	1	JALIL, ANMAR B MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139378	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
37009	Fee-for-Service	1669705406	1669705406	1	1	JALBUENA, PETER B MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109131	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
37023	Fee-for-Service	1538597075	1538597075	1	1	JANSEN, KATIE LYN	9/25/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	39304 FLAMINGO BAY	UNIT C	MURRIETA	CA	92563	8806	33	06065	33.55015923	-117.1319927	Riverside County
37064	Fee-for-Service	1700230521	1700230521	1	1	JIANG, YANG MD	9/27/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	161229	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
37136	Fee-for-Service	1679878250	1679878250	1	1	JOO, SOON HA LAC	8/11/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10445 FOLSOM BLVD	SUITE A	RANCHO CORDOVA	CA	95670	4610	34	06067	38.591415	-121.299048	Sacramento County
37194	Fee-for-Service	1841439239	1841439239	1	1	JAMSHIDIAN, FARZAD MD	12/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168604	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
37222	Fee-for-Service	1376567354	1376567354	1	1	JOHN R DEGUZMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	927 BROADWAY ST	STE 121	QUINCY	IL	62301	2727	00	None	39.93567782	-91.40041752	Adams County
37251	Fee-for-Service	1487064119	1487064119	1	1	JI, YONG H MD	4/5/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	138497	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
37280	Fee-for-Service	1235126475	1235126475	1	1	JACKSON, HAROLD W DO	12/8/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	3741	08	Family Practice	0	In state provider	None	4646 BROCKTON AVE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
37287	Fee-for-Service	1780826404	1780826404	1	1	JUDITH LYNN HOLINSWORTH	3/26/2009	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6069 TIMBER RIDGE DRIVE	None	MAGALIA	CA	95954	0000	04	06007	39.84514715	-121.6140445	Butte County
37313	Fee-for-Service	1538597075	1538597075	1	1	JANSEN, KATIE LYN	9/25/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	39304 FLAMINGO BAY	UNIT C	MURRIETA	CA	92563	8806	33	06065	33.55015923	-117.1319927	Riverside County
37318	Fee-for-Service	1245281443	1245281443	1	1	JJ&R EMERGENCY MEDICAL	4/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PARADISE VALLEY HOSP ER	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
37329	Fee-for-Service	1760602726	1760602726	1	1	JOHN MUIR HEALTH	2/4/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CONCORD CAMPUS	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
37349	Fee-for-Service	1306952957	1306952957	1	1	JONG LIU	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	125 N 18TH ST	STE C	MOUNT VERNON	WA	98273	3902	00	None	48.422061	-122.318878	Skagit County
37356	Fee-for-Service	1265721336	1265721336	1	1	JESSICA HOOTNICK	2/22/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3 MEETING HOUSE RD	STE 24	CHELMSFORD	MA	01824	2739	00	None	42.602121	-71.35029	Middlesex County
37368	Fee-for-Service	1699734376	1699734376	1	1	JOHNSON, M CRIS MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81436	68	Hematology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
37396	Fee-for-Service	1184618654	1184618654	1	1	JOHNSON, MELISSA A MD	8/14/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53137	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
37435	Fee-for-Service	1295703882	1295703882	1	1	JOHNNY WEI-TING SUN 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	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
37453	Fee-for-Service	1144410648	1144410648	1	1	JEFFERIES, KATHLEEN M	5/3/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
37509	Fee-for-Service	1306495015	1306495015	1	1	JONES, GARRICK PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
37598	Fee-for-Service	1023100013	1023100013	1	1	JAMES, LINDA E	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90251	41	Internal Medicine	0	In state provider	None	24355 LYONS AVENUE	STE 210	SANTA CLARITA	CA	91321	2381	19	06037	34.37868281	-118.5605291	Los Angeles County
37607	Fee-for-Service	1134153299	1134153299	2	1	JOHANSON, RONALD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34086	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
37614	Fee-for-Service	1477796845	1477796845	1	1	JAHNG, KENNETH H MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116022	20	Orthopedic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
37620	Fee-for-Service	1760602726	1760602726	1	1	JOHN MUIR HEALTH	2/4/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CONCORD CAMPUS	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
37657	Fee-for-Service	1699734376	1699734376	1	1	JOHNSON, M CRIS MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81436	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
37716	Fee-for-Service	1629110564	1629110564	1	1	JAMES A. NEWMAN, M.D.	4/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 S AUBURN ST	None	KENNEWICK	WA	99336	5621	00	None	46.19896647	-119.11855	Benton County
37755	Fee-for-Service	1871373712	1871373712	1	1	JESSICA DE LA ROSA	11/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER,	104 E OLIVE AVE	STE 201	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
37769	Fee-for-Service	1376640235	1376640235	1	1	JAVDAN, PARVIZ MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	34960	41	Internal Medicine	0	In state provider	None	1762 WESTWOOD BLVD	STE 300	LOS ANGELES	CA	90024	5641	19	06037	34.05057734	-118.4376712	Los Angeles County
37835	Fee-for-Service	1952706277	1952706277	1	1	JOHN F KENNEDY UNIVERSITY	4/11/2016	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
37886	Fee-for-Service	1073764569	1073764569	1	1	JONES, LAURA E DO	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10795	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
37887	Fee-for-Service	1023100013	1023100013	1	1	JAMES, LINDA E	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90251	01	General Practice	0	In state provider	None	24355 LYONS AVENUE	STE 210	SANTA CLARITA	CA	91321	2381	19	06037	34.37868281	-118.5605291	Los Angeles County
37899	Fee-for-Service	1134574528	1134574528	1	1	JACKSON, CAMILLE S MD	10/9/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	156408	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
37912	Fee-for-Service	1376604892	1376604892	1	1	JOHNSON, ELLEN C LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
37945	Fee-for-Service	1699734376	1699734376	1	1	JOHNSON, M CRIS MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81436	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
37984	Fee-for-Service	1841446143	1841446143	1	1	JOHNSON, LORRAINE R LCSW	9/18/2008	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	7737 PACIFIC AVENUE	None	LEMON GROVE	CA	91945	1740	37	06073	32.74164771	-117.0318216	San Diego County
38015	Fee-for-Service	1194753335	1194753335	1	1	JOHN J NICOTRA, MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
38053	Fee-for-Service	1467515718	1467515718	1	1	JULIAN, VANCE 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	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
38060	Fee-for-Service	1376640235	1376640235	1	1	JAVDAN, PARVIZ MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	34960	10	Gastroenterology (M.D. only)	0	In state provider	None	1762 WESTWOOD BLVD	STE 300	LOS ANGELES	CA	90024	5641	19	06037	34.05057734	-118.4376712	Los Angeles County
38121	Fee-for-Service	1952706277	1952706277	1	1	JOHN F KENNEDY UNIVERSITY	4/11/2016	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
38299	Fee-for-Service	1912693292	1912693292	1	1	JONAS, BRITTNEY L NP	9/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
38358	Fee-for-Service	1518108448	1518108448	1	1	JESSICA HU	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
38384	Fee-for-Service	1326624883	1326624883	1	1	JIMENEZ, JOSSUE L MD	6/13/2024	207R00000X	NA	Other	026	PHYSICIANS	183215	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
38411	Fee-for-Service	1952706277	1952706277	1	1	JOHN F KENNEDY UNIVERSITY	4/11/2016	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
38433	Fee-for-Service	1922485028	1922485028	1	1	JOLIN, CORTNEY L CRNA	10/28/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
38437	Fee-for-Service	1619048659	1619048659	1	1	JOHNSON, MICHAEL T MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	76807	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
38490	Fee-for-Service	1841361334	1841361334	1	1	JAYATILAKA, MATTHEW G MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	26403	40	Pediatrics	0	In state provider	INC	1045 ATLANTIC AVE	STE 818	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
38511	Fee-for-Service	1174275713	1174275713	1	1	JANJI CHIROPRACTIC CORPORATI	3/18/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	225 GLENOAKS BLVD	None	BURBANK	CA	91502	1317	19	06037	34.18412164	-118.3075846	Los Angeles County
38518	Fee-for-Service	1609497395	1609497395	1	1	JMJ HOSPICE CARE INC	12/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8640 BRENTWOOD BLVD	STE D1	BRENTWOOD	CA	94513	5687	07	06013	37.92650142	-121.6913814	Contra Costa County
38533	Fee-for-Service	1184058828	1184058828	1	1	JUNG, JAE Y LAC	3/6/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	N MEDICINE ACUPUNCTURE C	242 N ST ANDREWS PL	None	LOS ANGELES	CA	90004	4024	19	06037	34.075953	-118.3113525	Los Angeles County
38576	Fee-for-Service	1619190576	1619190576	1	1	JENKINS SKELTON, CARLA E	5/16/2011	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
38682	Fee-for-Service	1891159620	1891159620	1	1	JABRI, ZAIN T MD	6/1/2020	208M00000X	NA	Other	026	PHYSICIANS	160760	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
38713	Fee-for-Service	1457178709	1457178709	1	1	JAMES, GEORGIA	10/7/2024	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
38805	Fee-for-Service	1609497395	1609497395	1	1	JMJ HOSPICE CARE INC	12/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8640 BRENTWOOD BLVD	STE D1	BRENTWOOD	CA	94513	5687	07	06013	37.92650142	-121.6913814	Contra Costa County
38814	Fee-for-Service	1568579142	1568579142	1	1	JON S MOUSSALLY M.D.	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRUIT ST	None	BOSTON	MA	02114	2621	00	None	42.363216	-71.0687745	Suffolk County
38823	Fee-for-Service	1003953944	1003953944	1	1	JAFARIAN-BLOURCHIAN, ZAHRA	9/23/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
38890	Fee-for-Service	1679880025	1679880025	1	1	JAMIL, MOHAMMAD M MD	9/10/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	172172	33	Thoracic Surgery	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
38898	Fee-for-Service	1255859294	1255859294	1	1	JOHNSON, JACQUELINE D LMFT	6/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
38928	Fee-for-Service	1669465530	1669465530	1	1	JERRY M FIORAMONTI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3648 W ANTHEM WAY	BLDG A-100	ANTHEM	AZ	85086	0000	00	None	33.867441	-112.1371425	Maricopa County
38935	Fee-for-Service	1093452278	1093452278	1	1	JERRY KIM MD INC	8/11/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	350 VINTON AVE	202	POMONA	CA	91767	3000	19	06037	34.07937061	-117.746663	Los Angeles County
38982	Fee-for-Service	1114107935	1114107935	1	1	JOSE, POWELL O MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101413	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
39058	Fee-for-Service	1598863953	1598863953	1	1	JUNEJA, PAWAN K MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54113	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
39059	Fee-for-Service	1700879640	1700879640	1	1	JAGADISH MALAKAR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CORTLAND MEDICAL CARE	129 HOMER AVE	None	CORTLAND	NY	13045	0000	00	None	42.608682	-76.1857605	Cortland County
39109	Fee-for-Service	1003892316	1003892316	1	1	JANUMPALLY, LINGAIAH MD	5/31/1989	2084N0400X	NA	Neurology	026	PHYSICIANS	44785	13	Neurology (M.D. only)	0	In state provider	None	44902 10TH ST W	None	LANCASTER	CA	93534	2314	19	06037	34.699158	-118.148051	Los Angeles County
39272	Fee-for-Service	1841342334	1841342334	1	1	JOHN C FREMONT HEALTHCARE	1/1/1979	282NC0060X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
39298	Fee-for-Service	1487877908	1487877908	1	1	JOHN C FREMONT HLTHCARE	1/18/2005	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DIST-RURAL HLTH CLIN II	5186 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.49994116	-119.9766803	Mariposa County
39304	Fee-for-Service	1548259385	1548259385	1	1	JOHN P SMITH MD APC	7/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	NATIONAL AVENUE MED ASSO	14911 NATIONAL AVE	STE 1	LOS GATOS	CA	95032	2632	43	06085	37.25172742	-121.951483	Santa Clara County
39339	Fee-for-Service	1043606700	1043606700	1	1	JACOB, SAUL A MD	9/4/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156981	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
39395	Fee-for-Service	1255862389	1255862389	1	1	JOURNEY HOSPICE CARE INC	8/6/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	600 NORTH MOUNTAIN AVE	SUITE C203	UPLAND	CA	91786	4331	36	06071	34.10094187	-117.6700806	San Bernardino County
39522	Fee-for-Service	1386007375	1386007375	1	1	JEONG, JIYEON MD	4/29/2019	207R00000X	NA	Other	026	PHYSICIANS	154979	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
39553	Fee-for-Service	1497874317	1497874317	1	1	JONATHAN C WEINRACH MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10229 N 92ND ST	STE 102	SCOTTSDALE	AZ	85258	4562	00	None	33.579099	-111.878703	Maricopa County
39583	Fee-for-Service	1487877908	1487877908	1	1	JOHN C FREMONT HLTHCARE	1/18/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DIST-RURAL HLTH CLIN II	5186 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.49994116	-119.9766803	Mariposa County
39593	Fee-for-Service	1548259385	1548259385	1	1	JOHN P SMITH MD APC	7/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	NATIONAL AVENUE MED ASSO	14911 NATIONAL AVE	STE 1	LOS GATOS	CA	95032	2632	43	06085	37.25172742	-121.951483	Santa Clara County
39622	Fee-for-Service	1699943027	1699943027	1	1	JOHNSON, MEGAN C MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79052	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
39680	Fee-for-Service	1255862389	1255862389	1	1	JOURNEY HOSPICE CARE INC	8/6/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	600 NORTH MOUNTAIN AVE	SUITE C203	UPLAND	CA	91786	4331	36	06071	34.10094187	-117.6700806	San Bernardino County
39734	Fee-for-Service	1326278490	1326278490	1	10	JANESRI DE SILVA M.D. A PROF	3/8/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	8628 RESEDA BLVD.	None	NORTHRIDGE	CA	91324	4032	19	06037	34.22722956	-118.5360495	Los Angeles County
39745	Fee-for-Service	1811331432	1811331432	1	1	JERROD SPRING	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6655 S YALE AVE	None	TULSA	OK	74136	3326	00	None	36.06542494	-95.92006491	Tulsa County
39800	Fee-for-Service	1386909042	1386909042	1	1	JORDAN SINGLETON, M.D.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 W 9000 S	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
39923	Fee-for-Service	1487908646	1487908646	1	1	JANSKY, MATTHEW J LMFT	12/18/2018	390200000X	NA	Other	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
39936	Fee-for-Service	1871099416	1871099416	1	1	JABERI, FARNOSH MD	1/21/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174543	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
39993	Fee-for-Service	1295747566	1295747566	1	1	JOHN HERRING	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1415 HIGHWAY 25 NORTH	None	HEBER SPRINGS	AR	72543	1709	00	None	35.50636807	-92.02932875	Cleburne County
40026	Fee-for-Service	1477103570	1477103570	1	1	JACKSON, DENYSE F NP	7/15/2021	363LW0102X	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
40088	Fee-for-Service	1013448794	1013448794	1	1	JOHNSON, EMILY M MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	158383	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
40110	Fee-for-Service	1982657227	1982657227	1	1	JANOUT,MAREK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	122 W 7TH AVE	STE 310	SPOKANE	WA	99204	2352	00	None	47.649717	-117.4138155	Spokane County
40192	Fee-for-Service	1962752980	1962752980	1	1	JUNGHERR, ANNA S M LCSW	4/25/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	69271	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVENUE	WARD 95	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
40195	Fee-for-Service	1285664243	1285664243	1	1	JUAREZ, CARLOS MD	5/17/2018	174400000X	NA	Other	026	PHYSICIANS	73601	02	General Surgery	0	In state provider	None	1381 E HERNDON AVE STE 1	None	FRESNO	CA	93720	3307	10	06019	36.83688006	-119.7634634	Fresno County
40247	Fee-for-Service	1396860086	1396860086	1	1	JOHNSON, TAMARA S LCSW	2/3/2024	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
40252	Fee-for-Service	1346366911	1346366911	1	1	JEBRAILI, RAMIN M MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53938	20	Orthopedic Surgery	0	In state provider	None	1600 N ROSE AVE	STE 380	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
40304	Fee-for-Service	1558538256	1558538256	1	1	JONES, RAYMOND L DO	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9929	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
40314	Fee-for-Service	1689768079	1689768079	1	1	JEROME YATSKOWITZ, M.D.	1/25/2015	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
40319	Fee-for-Service	1770875841	1770875841	1	1	JACKSON, AMANDA K MD	11/21/2022	207P00000X	NA	Other	026	PHYSICIANS	182782	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
40357	Fee-for-Service	1821109224	1821109224	1	1	JONS, LEON 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	969 E HIGHWAY 33	None	CRETE	NE	68333	2547	00	None	40.63235001	-96.95202635	Saline County
40381	Fee-for-Service	1497711824	1497711824	1	1	JULIE M MAYO,DO	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
40382	Fee-for-Service	1760539860	1760539860	1	1	JEW, DAVID OD	2/11/2013	No Taxonomy Provided	NA	None	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
40386	Fee-for-Service	1033975891	1033975891	1	1	JOON SUH DO INC	7/1/2024	111NI0900X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVENUE	SUITE 508	CULVER CITY	CA	90232	2500	19	06037	34.02243278	-118.3981492	Los Angeles County
40421	Fee-for-Service	1205096476	1205096476	1	1	JONATHAN REITMAN M.D., INC.	11/19/2018	207RA0401X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
40484	Fee-for-Service	1356519193	1356519193	1	1	JONES, SIDNEY G MD	6/17/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	100637	20	Orthopedic Surgery	0	In state provider	None	6127 CLARK RD	STE 200	PARADISE	CA	95969	4177	04	06007	39.76304842	-121.6042302	Butte County
40494	Fee-for-Service	1437201654	1437201654	1	1	JAINI, ARVIND K MD	4/16/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50630	08	Family Practice	0	In state provider	None	828 SAN PABLO AVE	None	ALBANY	CA	94706	1567	01	06001	37.89159884	-122.2994097	Alameda County
40582	Fee-for-Service	1326278490	1326278490	1	15	JANESRI DE SILVA M.D. A PROF	2/13/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	24330 MCBEAN PKWY	None	VALENCIA	CA	91355	1929	19	06037	34.39471253	-118.560951	Los Angeles County
40672	Fee-for-Service	1073675112	1073675112	1	1	JORDAN LAU INOUYE D.O.	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	762 W 400 S	None	SPRINGVILLE	UT	84663	3096	00	None	40.16121315	-111.6255482	Utah County
40696	Fee-for-Service	1427283902	1427283902	1	1	JAFRI, SYED Z A MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119518	08	Family Practice	0	In state provider	None	801 E STREET	None	PATTERSON	CA	95363	2670	50	06099	37.46668786	-121.1342171	Stanislaus County
40715	Fee-for-Service	1588724504	1588724504	1	1	JONES, DONALD V MD PC	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52947	33	Thoracic Surgery	0	In state provider	None	300 SIERRA COLLEGE DR	STE 240	GRASS VALLEY	CA	95945	5086	29	06057	39.23625806	-121.054471	Nevada County
40739	Fee-for-Service	1134682008	1134682008	1	2	JANZ FAMILY THERAPY INCORPOR	4/12/2024	101Y00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ATED	1357 WEST SHAW AVENUE	100	FRESNO	CA	93711	3618	10	06019	36.80824094	-119.8162512	Fresno County
40834	Fee-for-Service	1891771309	1891771309	1	1	JOHANOS,ANDREW M MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
40837	Fee-for-Service	1881069938	1881069938	1	1	JACKSON, MEGAN PT	3/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2490 S MAIN ST	None	RED BLUFF	CA	96080	4337	52	06103	40.15020135	-122.2183126	Tehama County
40841	Fee-for-Service	1952445579	1952445579	1	1	JAGUSCH, CHRISTIAN R MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66125	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
40866	Fee-for-Service	1124090436	1124090436	1	1	JIMENEZ, ERNESTO M MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37394	05	Anesthesiology	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
40988	Fee-for-Service	1790987394	1790987394	1	1	JOSHI, DHAGASH P MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116823	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
41026	Fee-for-Service	1134682008	1134682008	1	2	JANZ FAMILY THERAPY INCORPOR	8/16/2022	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ATED	1357 WEST SHAW AVENUE	100	FRESNO	CA	93711	3618	10	06019	36.80824094	-119.8162512	Fresno County
41065	Fee-for-Service	1679512560	1679512560	1	1	JAZAYERI, M JAY MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33300	20	Orthopedic Surgery	0	In state provider	None	2690 PACIFIC AVE	STE 300	LONG BEACH	CA	90806	2660	19	06037	33.805854	-118.1936805	Los Angeles County
41102	Fee-for-Service	1336186022	1336186022	1	1	JAMES LUETHKE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1502 POTOMAC	None	AURORA	CO	80012	0000	00	None	39.69001965	-104.831075	Arapahoe County
41113	Fee-for-Service	1902887227	1902887227	1	1	JOHNSON, MARY E MD	9/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75167	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
41202	Fee-for-Service	1639798580	1639798580	1	1	JOHNSON, BEVAN E MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	185785	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
41205	Fee-for-Service	1770592578	1770592578	1	1	JAVED, USMAN MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
41254	Fee-for-Service	1588046163	1588046163	1	1	JOHAL, ABIGAIL C PSYD	10/30/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
41294	Fee-for-Service	1023429412	1023429412	1	1	JAVAID, NADIA S MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146164	01	General Practice	0	In state provider	None	2006 SHAW AVE	None	CLOVIS	CA	93611	4192	10	06019	36.80848025	-119.6771991	Fresno County
41331	Fee-for-Service	1992726368	1992726368	1	1	JONES-OYEFESO, VENESSA CRNA	4/4/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
41372	Fee-for-Service	1033170519	1033170519	1	1	JENNIFER FREEMAN	6/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 MARTIN LUTHER KING	None	SPRINGFIELD	OR	97477	7514	00	None	44.0784397	-123.0311559	Lane County
41399	Fee-for-Service	1366595639	1366595639	1	1	JOHNSON, KIMBERLY D OD	10/6/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3855 BROAD ST	STE B	SAN LUIS OBISPO	CA	93401	0000	40	06079	35.2504674	-120.6442585	San Luis Obispo County
41401	Fee-for-Service	1508238304	1508238304	1	1	JOHNSON, SARAH NP	7/18/2022	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
41415	Fee-for-Service	1134356884	1134356884	1	1	JOSEPH MAYERLE	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1455 SAINT FRANCIS AVE	None	SHAKOPEE	MN	55379	3374	00	None	44.771976	-93.502944	Scott County
41429	Fee-for-Service	1053800102	1053800102	1	1	JAMSHIDIAN, MITRA S MD	10/2/2023	246ZN0300X	NA	Other	026	PHYSICIANS	164761	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
41438	Fee-for-Service	1417081274	1417081274	1	1	JAFFE, MICHAEL P MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88623	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
41461	Fee-for-Service	1720254337	1720254337	1	1	JORDAN, DENEE PHD	8/2/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8404 JOAN LN	None	WEST HILLS	CA	91304	5432	19	06037	34.22244716	-118.6344912	Los Angeles County
41536	Fee-for-Service	1538246475	1538246475	1	1	JOSEPH, WALDO L MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62032	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
41569	Fee-for-Service	1790966802	1790966802	1	1	JACKSON, JODILANA K MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97222	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
41572	Fee-for-Service	1215920673	1215920673	1	1	JACOBS, JOSHUA S MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	76901	03	Allergy	0	In state provider	None	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	07	06013	37.92948925	-122.0275099	Contra Costa County
41594	Fee-for-Service	1780206813	1780206813	1	1	JEFFREY N. ROBERTS, M.D., IN	11/20/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C.	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
41637	Fee-for-Service	1245436633	1245436633	1	1	JON FEMLING M.D., PH.D.	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
41775	Fee-for-Service	1437823937	1437823937	1	2	JC ASSISTED TRANS. INC	7/22/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	390 N PALM AVE	SUITE A	RIALTO	CA	92376	5867	36	06071	34.106193	-117.3728775	San Bernardino County
41867	Fee-for-Service	1740495035	1740495035	1	2	JONES, CHRISTOPHER S LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
41906	Fee-for-Service	1386107670	1386107670	1	1	JOCHAM, KEVIN P MD	2/3/2025	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	10123 SE MARKET STREET	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
41944	Fee-for-Service	1811994437	1811994437	1	1	JEYAKUMAR, VASANTHAKUMAR	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49813	41	Internal Medicine	0	In state provider	None	500 ALAMITOS AVE	None	LONG BEACH	CA	90802	1614	19	06037	33.77330398	-118.1807838	Los Angeles County
41995	Fee-for-Service	1760596985	1760596985	1	1	JIN, STEVE H MD	3/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105826	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	SUITE 209	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
42118	Fee-for-Service	1467630806	1467630806	1	1	JACKSON-SCOTT, ERIC D MD	5/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	115195	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1887 MONTEREY ROAD	STE 200	SAN JOSE	CA	95112	6192	43	06085	37.308636	-121.8664102	Santa Clara County
42167	Fee-for-Service	1851709240	1851709240	1	1	JAY IINUMA, MD, INC	12/7/2020	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	301 W HUNTINGTON DR	608	ARCADIA	CA	91007	1516	19	06037	34.13481053	-118.0425638	Los Angeles County
42201	Fee-for-Service	1255466801	1255466801	1	1	JIMENEZ, DANIEL MD INC	11/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75231	08	Family Practice	0	In state provider	None	801 N TUSTIN AVE	STE 204	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
42204	Fee-for-Service	1528567344	1528567344	1	1	JOHNSON, TANIA M NP	1/10/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	10	06019	36.7796958	-119.7618088	Fresno County
42262	Fee-for-Service	1306838321	1306838321	1	1	JACKSON, ALTHEA J MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88296	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
42286	Fee-for-Service	1760596985	1760596985	1	1	JIN, STEVE H MD	3/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105826	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	SUITE 209	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
42308	Fee-for-Service	1487655288	1487655288	1	1	JEFFRE, BENSON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
42311	Fee-for-Service	1760677835	1760677835	1	1	JULIAN, EMILY C PHD	4/26/2023	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
42332	Fee-for-Service	1730216508	1730216508	2	1	JAN & GAILS CARE HOMES INC	9/29/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2005 ATLANTIC AVE	None	TULARE	CA	93274	8240	54	06107	36.20302894	-119.3159278	Tulare County
42390	Fee-for-Service	1881153229	1881153229	1	1	JENSEN, BRYCE CRNA	10/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 MAGELLAN DR.	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
42544	Fee-for-Service	1205847209	1205847209	1	1	JOHNSON, MICHAEL A 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
42735	Fee-for-Service	1265106421	1265106421	1	1	JONES, LESLEY K PT	9/27/2021	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
42788	Fee-for-Service	1265510903	1265510903	1	1	JAMES, ARCHIE K MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45444	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
42794	Fee-for-Service	1407855844	1407855844	1	1	JAMIS-DOW, CARLOS A MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143106	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
42855	Fee-for-Service	1790831816	1790831816	1	1	JETT, MICAELA A MD	10/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	112725	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
42882	Fee-for-Service	1508860438	1508860438	1	1	JOHN J. ANTON, M.D.	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 KANAWHA BLVD E	None	CHARLESTON	WV	25301	2400	00	None	38.34470937	-81.63296112	Kanawha County
42910	Fee-for-Service	1326278490	1326278490	1	7	JANESRI DE SILVA M.D. A PROF	4/3/2014	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1530 E CHEVY CHASE DR	STE 202	GLENDALE	CA	91206	4139	19	06037	34.150689	-118.2303855	Los Angeles County
43023	Fee-for-Service	1629128020	1629128020	1	1	J&T CARE, LLC	8/10/1998	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1250 HAYES ST	None	SAN FRANCISCO	CA	94117	1512	38	06075	37.77510685	-122.4370546	San Francisco County
43064	Fee-for-Service	1164757076	1164757076	1	1	JOO, DAEKEUN MD	5/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93394	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
43100	Fee-for-Service	1164733358	1164733358	1	1	JUNN, JUSTIN H MD	9/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169249	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
43116	Fee-for-Service	1376695197	1376695197	1	1	JUNG, JENNIFER A	4/28/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
43211	Fee-for-Service	1831342195	1831342195	1	1	JABER, JAMES J MD	12/12/2017	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	151528	04	Otology, Laryngology, Rhinology	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	19	06037	34.05101259	-118.217259	Los Angeles County
43225	Fee-for-Service	1295197606	1295197606	1	1	JUN-IHN, ESTHER MD	9/28/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	152561	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
43234	Fee-for-Service	1750339305	1750339305	1	1	JONES, HEATHER D MD	8/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99138	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
43271	Fee-for-Service	1790837722	1790837722	1	1	JAN, ALFRED OD	8/1/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
43274	Fee-for-Service	1689744856	1689744856	1	1	JERSEY CITY MEDICAL CENTER	3/3/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	355 GRAND STREET	None	JERSEY CITY	NJ	07302	9998	00	None	40.71668982	-74.05033042	Hudson County
43315	Fee-for-Service	1255741633	1255741633	1	1	JABBOUR, MOUSSA MD	3/31/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	148314	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
43329	Fee-for-Service	1891103735	1891103735	1	1	JOSHI, DHRUPAD DO	12/10/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	14263	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
43339	Fee-for-Service	1689726804	1689726804	1	1	JOHAL, JASVINDER S MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83300	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
43365	Fee-for-Service	1033505219	1033505219	1	1	JUHN, ALEXANDER MD	6/17/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	162718	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
43384	Fee-for-Service	1124738034	1124738034	1	1	JOSHUA MARSHALL LICENSED CLI	11/1/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER IN	41945 BIG BEAR BLVD	208	BIG BEAR LAKE	CA	92315	2030	36	06071	34.24334115	-116.8869688	San Bernardino County
43407	Fee-for-Service	1447810890	1447810890	1	1	JOHNSON, SUSAN E LPCC	2/10/2025	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
43470	Fee-for-Service	1093532582	1093532582	1	1	JOHNSON, ANTOINETTE L	4/7/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
43512	Fee-for-Service	1922149509	1922149509	1	1	JONBEC CARE, INC	2/24/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	STILLMAN HOUSE	1528 STILLMAN AVE	None	REDLANDS	CA	92374	4174	36	06071	34.06183655	-117.15084	San Bernardino County
43521	Fee-for-Service	1750339305	1750339305	1	1	JONES, HEATHER D MD	8/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99138	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
43523	Fee-for-Service	1700150885	1700150885	1	1	JAIN, AKSHAT MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144710	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
43548	Fee-for-Service	1215009964	1215009964	1	1	JAHROMI, SHAHZAD MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84846	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
43562	Fee-for-Service	1689744856	1689744856	1	1	JERSEY CITY MEDICAL CENTER	3/3/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	355 GRAND STREET	None	JERSEY CITY	NJ	07302	9998	00	None	40.71668982	-74.05033042	Hudson County
43653	Fee-for-Service	1285782276	1285782276	1	1	JOHNSON, FLORA H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33898	01	General Practice	0	In state provider	None	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
43678	Fee-for-Service	1689704678	1689704678	1	1	JUN, STEPHANIE L MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78912	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
43703	Fee-for-Service	1275617771	1275617771	1	1	JAMNANI, BEHROUZ MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86358	02	General Surgery	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
43809	Fee-for-Service	1700150885	1700150885	1	1	JAIN, AKSHAT MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144710	78	Neoplastic Diseases/Oncology	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
43810	Fee-for-Service	1225234768	1225234768	1	1	JOHNSON, THOMAS S LMFT	10/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1433 11TH ST	SUITE C	ARCATA	CA	95521	5712	12	06023	40.87202203	-124.0927329	Humboldt County
43939	Fee-for-Service	1285782276	1285782276	1	1	JOHNSON, FLORA H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33898	08	Family Practice	0	In state provider	None	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
43961	Fee-for-Service	1386890549	1386890549	1	1	JAVAN, ARZHANG C MD	2/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115850	77	Infectious Disease	0	In state provider	None	8635 W 3RD STREET	1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
43989	Fee-for-Service	1275617771	1275617771	1	1	JAMNANI, BEHROUZ MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86358	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
44040	Fee-for-Service	1285637967	1285637967	1	1	JOHNSON, ERNEST E MD	2/1/1983	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	19668	04	Otology, Laryngology, Rhinology	0	In state provider	None	3810 J ST	None	SACRAMENTO	CA	95816	5521	34	06067	38.569743	-121.455378	Sacramento County
44084	Fee-for-Service	1932119351	1932119351	1	1	JUAREZ, SARA B MD	10/28/2019	207R00000X	NA	Other	026	PHYSICIANS	160847	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
44097	Fee-for-Service	1700150885	1700150885	1	1	JAIN, AKSHAT MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144710	68	Hematology	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
44139	Fee-for-Service	1205972296	1205972296	1	1	JONES, LAYBON	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39826	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44192	Fee-for-Service	1164633327	1164633327	1	1	JESSICA COZZENS MD	10/21/2013	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
44200	Fee-for-Service	1912137878	1912137878	1	1	JOSEPH, NANDINI A MD	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	94427	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
44263	Fee-for-Service	1891393963	1891393963	1	1	JUDES, DANIEL PHD	1/13/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
44452	Fee-for-Service	1326574518	1326574518	1	1	JANG, MICHAEL C MD	4/7/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	161059	None	None	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
44458	Fee-for-Service	1174702377	1174702377	1	3	JEREMY IAN GROSSER, M.D., IN	9/27/2022	282N00000X	NA	Hospitals	026	PHYSICIANS	None	None	None	0	In state provider	C.	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
44476	Fee-for-Service	1568876837	1568876837	1	1	JOSEPH, SHANE P MD	1/8/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	138026	-	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
44481	Fee-for-Service	1326104670	1326104670	1	1	JENG, MICHAEL R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83227	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
44510	Fee-for-Service	1215015706	1215015706	1	1	JONES, AARON A CRNA	4/27/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
44580	Fee-for-Service	1366275992	1366275992	1	1	JENNA SETO LICENSED CLINICAL	10/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR	SUITE 234	PALM DESERT	CA	92211	0484	33	06065	33.75833451	-116.3114325	Riverside County
44688	Fee-for-Service	1942824198	1942824198	1	1	JASLEEN TIWANA MD INC	7/10/2020	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2700 F ST	100	BAKERSFIELD	CA	93301	1849	15	06029	35.384184	-119.023442	Kern County
44725	Fee-for-Service	1548532658	1548532658	1	1	JALILVAND, ZAKIAT N DO	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12141	41	Internal Medicine	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
44768	Fee-for-Service	1326104670	1326104670	1	1	JENG, MICHAEL R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83227	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
44859	Fee-for-Service	1649379140	1649379140	1	1	JUBRAN, RIMA F MD	10/1/1999	2080P0207X	NA	Hematology	026	PHYSICIANS	68578	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
44871	Fee-for-Service	1407641087	1407641087	1	1	JOY, LAUREN A	4/14/2025	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	37	06073	0	0	None
44993	Fee-for-Service	1225371925	1225371925	1	1	JOHAL, MANMEET K NP	7/25/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
45016	Fee-for-Service	1114253515	1114253515	1	1	JUNG, SUSAN S MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77563	01	General Practice	0	In state provider	None	9844 GENESEE AVE	STE 100	LA JOLLA	CA	92037	1209	37	06073	32.883714	-117.2266425	San Diego County
45022	Fee-for-Service	1386831188	1386831188	2	1	JOHNSTON, CHRISTINE M MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	77456	08	Family Practice	0	In state provider	None	200 S WELLS RD	SUITE 100	VENTURA	CA	93003	1302	56	06111	34.29321532	-119.1597424	Ventura County
45140	Fee-for-Service	1447213723	1447213723	1	1	JOSHUA MICHAEL MCDONALD MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
45151	Fee-for-Service	1649379140	1649379140	1	1	JUBRAN, RIMA F MD	10/1/1999	2080P0207X	NA	Hematology	026	PHYSICIANS	68578	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
45389	Fee-for-Service	1881842920	1881842920	1	1	JONES GARRETT, THERESE D	1/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1350 HAYES STREET	SUITE B10	BENICIA	CA	94510	2933	48	06095	38.04764833	-122.139033	Solano County
45407	Fee-for-Service	1124260807	1124260807	1	1	JENNIFER M. MITZMAN, M.D.	7/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
45447	Fee-for-Service	1134456510	1134456510	1	2	JUSTIN PAQUETTE MD CORPORATI	7/9/2021	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ON	3800 J STREET	210	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
45615	Fee-for-Service	1750846655	1750846655	1	1	JAMES COURT MANOR INC	9/25/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1316 JAMES CT	None	SAN MATEO	CA	94401	3177	41	06081	37.56862729	-122.3094274	San Mateo County
45658	Fee-for-Service	1093150476	1093150476	1	1	JAIN, SUSHIL K MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148234	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
45709	Fee-for-Service	1124079611	1124079611	1	1	JONES, 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	400 SW 235TH AVE	None	MINERAL WELLS	TX	76067	8246	00	None	0	0	None
45712	Fee-for-Service	1306457148	1306457148	1	1	JASMINE HOSPICE INC	9/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14120 VICTORY BLVD	105	VAN NUYS	CA	91401	1927	19	06037	34.18663554	-118.440702	Los Angeles County
45735	Fee-for-Service	1194818542	1194818542	1	1	JENKINS, HERMAND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13611 E COLFAX AVE	None	AURORA	CO	80045	5701	00	None	39.74039327	-104.8302052	Adams County
45814	Fee-for-Service	1275585127	1275585127	1	1	JOYCE, ROBERT J OD	7/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3666 4TH AVE	None	SAN DIEGO	CA	92103	4106	37	06073	32.74457836	-117.1616245	San Diego County
45825	Fee-for-Service	1669660338	1669660338	1	1	JONES III, WALTER MD INC	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54962	41	Internal Medicine	0	In state provider	None	255 TERRACINA BLVD	STE 101	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
45841	Fee-for-Service	1225109101	1225109101	1	1	JOU, WILLIAM W MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82111	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
45850	Fee-for-Service	1043828494	1043828494	1	1	JOHNSON, SYDNEY S LMFT	2/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
45896	Fee-for-Service	1972558807	1972558807	1	1	JAIN, ARTI MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77790	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
45941	Fee-for-Service	1568420180	1568420180	1	1	JON C KOOIKER M.D.	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	525 LILLY RD NE	STE 210	OLYMPIA	WA	98506	5101	00	None	47.053944	-122.8444465	Thurston County
45983	Fee-for-Service	1548456718	1548456718	1	1	JOU, RONALD M MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96471	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
46003	Fee-for-Service	1306457148	1306457148	1	1	JASMINE HOSPICE INC	9/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14120 VICTORY BLVD	105	VAN NUYS	CA	91401	1927	19	06037	34.18663554	-118.440702	Los Angeles County
46031	Fee-for-Service	1891785820	1891785820	1	1	JOYCE, MATT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6308	00	None	43.600527	-116.3518425	Ada County
46046	Fee-for-Service	1902979602	1902979602	1	1	JAMES A TAYLOR, 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	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
46047	Fee-for-Service	1528421740	1528421740	1	1	JOB, JENESSA K MD	11/17/2020	207L00000X	NA	Other	026	PHYSICIANS	168438	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
46067	Fee-for-Service	1689802803	1689802803	1	1	JEDICK, ROCKY P J MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
46096	Fee-for-Service	1316332547	1316332547	1	1	JAUREGUI, MONIKA E CNP	12/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
46124	Fee-for-Service	1003872870	1003872870	1	1	JOHN,MALCOLM D MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84379	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
46157	Fee-for-Service	1598304446	1598304446	1	2	JENNY HUONG LE, O.D., A PROF	5/15/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	TRY	44407 10TH STREET WEST	B	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
46213	Fee-for-Service	1689823478	1689823478	1	1	JONES, LUCAS A MD	2/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	110688	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
46236	Fee-for-Service	1255361895	1255361895	1	1	JARAMILLO, MARY D	4/30/1988	207R00000X	NA	Other	026	PHYSICIANS	62626	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
46308	Fee-for-Service	1821201898	1821201898	1	1	JUNG, MICHAEL C MD	6/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94843	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
46362	Fee-for-Service	1700428737	1700428737	1	1	JORDAN, TRACY L PHD	5/27/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
46445	Fee-for-Service	1285744243	1285744243	1	1	JAMESON, JOHN THOMAS	4/10/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	38344	22	Pathology (M.D. only)	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
46619	Fee-for-Service	1194971473	1194971473	1	1	JANUS OF SANTA CRUZ	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	516 CHESTNUT ST	None	SANTA CRUZ	CA	95060	3669	44	06087	36.97318765	-122.0307608	Santa Cruz County
46645	Fee-for-Service	1447544614	1447544614	1	1	JANG, YOONJUNG DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11292	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
46656	Fee-for-Service	1215150529	1215150529	1	1	JOSHUA INTERNATIONAL MEDICAL	5/5/1994	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	7872 WALKER ST	None	LA PALMA	CA	90623	1796	30	06059	33.84787056	-118.0372511	Orange County
46659	Fee-for-Service	1053754366	1053754366	1	1	JIN, RICHARD C MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134306	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
46732	Fee-for-Service	1356495261	1356495261	1	1	JAMES, ADRIAN L MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	79583	-	NOT APPLICABLE	0	In state provider	None	700 ADELINE STREET	None	OAKLAND	CA	94607	2608	01	06001	37.80430011	-122.2879962	Alameda County
46775	Fee-for-Service	1386703031	1386703031	1	1	JANG, SEW-CHUNG MD	1/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55482	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
46804	Fee-for-Service	1578720462	1578720462	1	1	JOHAL, AMANDEEP K	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115466	None	None	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
46842	Fee-for-Service	1770160996	1770160996	1	1	JONES, CHLOE A MD	10/2/2024	207R00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	2970 HILLTOP MALL RD.	304	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
46928	Fee-for-Service	1518109420	1518109420	1	1	JEYAKUMAR, GHAYATHRI MD	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149541	68	Hematology	0	In state provider	None	43112 15TH ST W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
46941	Fee-for-Service	1477091965	1477091965	1	1	JUAREZ, BIANCA NP	4/27/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
46961	Fee-for-Service	1356388177	1356388177	1	1	JAHROMI, MEHDI S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64559	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
47049	Fee-for-Service	1457989345	1457989345	1	1	JACOBSON, DUNCAN DO	8/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20051	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
47124	Fee-for-Service	1518407113	1518407113	1	1	JAMES W BRASWELL	12/12/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	620 E HIGHLAND AVENUE	None	REDLANDS	CA	92374	6231	36	06071	34.04507855	-117.1648575	San Bernardino County
47158	Fee-for-Service	1043970288	1043970288	1	1	JINJU HEALTH CARE, INC	10/4/2023	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	1617 BEVERLY BLVD	None	LOS ANGELES	CA	90026	5710	19	06037	34.06368919	-118.2635672	Los Angeles County
47164	Fee-for-Service	1528091964	1528091964	1	1	JAVAID, MAZHAR MD	7/12/2001	207R00000X	NA	Other	026	PHYSICIANS	38439	41	Internal Medicine	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
47223	Fee-for-Service	1518109420	1518109420	1	1	JEYAKUMAR, GHAYATHRI MD	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149541	78	Neoplastic Diseases/Oncology	0	In state provider	None	43112 15TH ST W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
47265	Fee-for-Service	1154432482	1154432482	1	1	JENSEN, AARON R MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113981	02	General Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
47287	Fee-for-Service	1073046132	1073046132	1	1	JOLLY, KANWAR S MD	12/11/2020	207R00000X	NA	Other	026	PHYSICIANS	170209	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
47299	Fee-for-Service	1710364781	1710364781	1	1	JAVADI, CHRISTOPHER S MD	7/11/2022	208600000X	NA	General Surgery	026	PHYSICIANS	143893	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
47384	Fee-for-Service	1982686176	1982686176	1	1	JONES, GEORGE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S CLARK ST	None	BUTTE	MT	59701	2328	00	None	46.00840837	-112.5461616	Silver Bow County
47400	Fee-for-Service	1740707223	1740707223	1	1	JAMES, JANET L LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
47407	Fee-for-Service	1275111528	1275111528	1	1	JORDAN, DARYL MD	5/14/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	179961	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47451	Fee-for-Service	1528091964	1528091964	1	1	JAVAID, MAZHAR MD	7/12/2001	207R00000X	NA	Other	026	PHYSICIANS	38439	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
47474	Fee-for-Service	1972828416	1972828416	1	1	JULIEN, ANNA M DO	9/5/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13334	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
47517	Fee-for-Service	1396759338	1396759338	1	1	JOHNSON, JOY L LCSW	9/5/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	465 34TH ST	None	OAKLAND	CA	94609	2815	01	06001	37.82207411	-122.2647332	Alameda County
47555	Fee-for-Service	1154432482	1154432482	1	1	JENSEN, AARON R MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113981	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
47610	Fee-for-Service	1326278490	1326278490	1	13	JANESRI DE SILVA M.D. A PROF	11/12/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	75 N. SANTA ANITA AVE	206	ARCADIA	CA	91006	3112	19	06037	34.14122978	-118.0316312	Los Angeles County
47678	Fee-for-Service	1912467960	1912467960	1	1	JONES, MATTHEW MD	4/16/2025	207RH0003X	NA	Oncology	026	PHYSICIANS	176643	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
47680	Fee-for-Service	1134530108	1134530108	1	1	JAGDEO, ROCHELLE M MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140719	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
47686	Fee-for-Service	1265435564	1265435564	1	1	JAMES K BAZEMORE, JR., MD	8/23/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4700 WATERS AVE	None	SAVANNAH	GA	31404	6220	00	None	32.030406	-81.088569	Chatham County
47799	Fee-for-Service	1871131979	1871131979	1	1	JANETS ENTERPRISE INC	5/22/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25084 TULIP AVE	None	LOMA LINDA	CA	92354	3446	36	06071	34.04693659	-117.2567014	San Bernardino County
47872	Fee-for-Service	1518908714	1518908714	1	1	JABOR,MILED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3610 24TH ST	None	LUBBOCK	TX	79410	0000	00	None	33.5723535	-101.8938375	Lubbock County
47918	Fee-for-Service	1053422527	1053422527	1	1	JONES, JAMES H MD	3/11/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75270	08	Family Practice	0	In state provider	None	535 W 25TH ST	STE C	MERCED	CA	95340	2801	24	06047	37.30968971	-120.4794777	Merced County
47924	Fee-for-Service	1760814917	1760814917	1	1	JOSEPHSON, WILLIAM Y MD INC	10/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 100A	NORTHRIDGE	CA	91325	5405	19	06037	34.25755945	-118.50471	Los Angeles County
47926	Fee-for-Service	1144783838	1144783838	1	1	JEBAIN, JOSEPH S	11/14/2023	208M00000X	NA	Other	026	PHYSICIANS	191397	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
47976	Fee-for-Service	1528563350	1528563350	1	1	JOSHI, RHUCHA MD	8/6/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	166033	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
47987	Fee-for-Service	1922099324	1922099324	1	1	JENSON, KRAIG 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	1385 E 750 N	None	OREM	UT	84097	5480	00	None	40.31127548	-111.6628561	Utah County
48052	Fee-for-Service	1194905711	1194905711	1	1	JAIN, ATUL K MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92495	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	STE 1-340	LOS ANGELES	CA	90095	7002	19	06037	34.06489065	-118.4443287	Los Angeles County
48295	Fee-for-Service	1073182077	1073182077	1	1	JOHNSON, EMILY PHD	3/6/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
48301	Fee-for-Service	1982100665	1982100665	1	1	JENNER, ZACHARY B MD	11/13/2024	207R00000X	NA	Other	026	PHYSICIANS	165863	30	Radiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
48304	Fee-for-Service	1104489137	1104489137	1	1	JAFARI, NICKEY	9/5/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	186860	None	None	0	In state provider	None	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	50	06099	37.66975543	-120.9724048	Stanislaus County
48325	Fee-for-Service	1124515119	1124515119	1	1	JEFFREY BROOKS MD INC	7/17/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	935 TRANCAS STREET	STE 2C	NAPA	CA	94558	2932	28	06055	38.32367324	-122.294977	Napa County
48330	Fee-for-Service	1437344942	1437344942	1	1	JOHNSTON, CHRISTINA B MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76197	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
48367	Fee-for-Service	1740260512	1740260512	1	1	JOOLHAR, FOWROOZ S MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55067	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	1510 S CENTRAL AVE	STE 650	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
48440	Fee-for-Service	1629537824	1629537824	1	1	JONES, CAMERON	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	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
48493	Fee-for-Service	1629179205	1629179205	1	1	JOURNEY LITE OF THE CENTRAL	9/18/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	COAST LLC	339 S MOORPARK RD	SUITE 339	THOUSAND OAKS	CA	91361	1008	56	06111	34.17369227	-118.8765488	Ventura County
48589	Fee-for-Service	1982100665	1982100665	1	1	JENNER, ZACHARY B MD	11/13/2024	207R00000X	NA	Other	026	PHYSICIANS	165863	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
48671	Fee-for-Service	1083757470	1083757470	1	1	JUBB, SEAN L LCSW	4/20/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER 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
48713	Fee-for-Service	1588683510	1588683510	1	1	JEFFREY K EVANS	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
48723	Fee-for-Service	1710472345	1710472345	1	1	JUSTIN J. SHARP, A MEDICAL C	11/29/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ORPORATION	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
48754	Fee-for-Service	1194704163	1194704163	1	1	JOHN OBRIEN	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 ROUND VALLEY DR	None	PARK CITY	UT	84060	7552	00	None	40.68736413	-111.4675063	Summit County
48776	Fee-for-Service	1295925501	1295925501	1	1	JOUDY, RAEDA S PHD	12/11/2018	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
48792	Fee-for-Service	1295757573	1295757573	1	1	JONATHAN W BLANCH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11925 SOUTH STATE ST	None	DRAPER	UT	84020	7735	00	None	40.53539574	-111.8914376	Salt Lake County
48799	Fee-for-Service	1023345048	1023345048	1	1	JUILLARD, CATHERINE J MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99965	02	General Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
48890	Fee-for-Service	1316122377	1316122377	1	1	JEFFREY H. HUNT	4/4/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	855 BORDEAUX WAY	#200	NAPA	CA	94558	9568	28	06055	38.24914335	-122.271666	Napa County
48979	Fee-for-Service	1003346180	1003346180	1	1	JARJOUR, SARAH MD	2/19/2024	207L00000X	NA	Other	026	PHYSICIANS	163083	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
49078	Fee-for-Service	1649386558	1649386558	2	1	JAIN, RAVIN MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52528	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
49093	Fee-for-Service	1669690020	1669690020	1	1	JEWISH FAMILY & CHILD	6/25/1999	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	L'CHAIM ADULT DAY HEALTH	2534 JUDAH ST	None	SAN FRANCISCO	CA	94122	1438	38	06075	37.76117118	-122.4893591	San Francisco County
49202	Fee-for-Service	1124515119	1124515119	1	3	JEFFREY BROOKS MD INC	7/18/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1360 BURTON DRIVE	STE 160	VACAVILLE	CA	95687	3560	48	06095	38.36439485	-121.9548858	Solano County
49307	Fee-for-Service	1477506756	1477506756	1	1	JENNIFER CROFFORD FREEMAN	4/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
49310	Fee-for-Service	1316407067	1316407067	1	1	JOSHI, BHAVIN DO	12/7/2023	207R00000X	NA	Other	026	PHYSICIANS	19805	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
49336	Fee-for-Service	1801884564	1801884564	1	1	JOHNSON, SCOTT A	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	650 SANITARIUM RD	None	DEER PARK	CA	94576	0000	28	06055	38.5417293	-122.4756328	Napa County
49363	Fee-for-Service	1245676618	1245676618	1	1	JMC PHARMACY INC	1/22/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7974 HAVEN AVE	#120	RANCHO CUCAMONGA	CA	91730	3052	36	06071	34.10875445	-117.5759905	San Bernardino County
49394	Fee-for-Service	1700835055	1700835055	1	1	JOHN T HALGREN MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
49469	Fee-for-Service	1780040840	1780040840	1	1	JOHN J LEE MD A PROFESSIONAL	5/22/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	CORPORATION	35400 BOB HOPE DR	STE 206	RANCHO MIRAGE	CA	92270	1774	33	06065	33.7914	-116.4058625	Riverside County
49571	Fee-for-Service	1689735169	1689735169	1	1	JUNG, CHRISTOPHER A PT	6/21/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
49582	Fee-for-Service	1851824692	1851824692	1	1	JUBRAN, ALEXANDRA J DO	1/4/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17490	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
49645	Fee-for-Service	1477539278	1477539278	1	1	JENNIFER LEE BROWN MD	5/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
49655	Fee-for-Service	1396217758	1396217758	1	1	JOHNSON, BRITTANY N CNP	5/17/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1501 COMMONWEALTH	None	FULLERTON	CA	92833	2727	30	06059	33.87020089	-117.9476741	Orange County
49681	Fee-for-Service	1205856168	1205856168	1	1	JONES, NICOLE L DO	9/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8084	01	General Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
49806	Fee-for-Service	1891102638	1891102638	1	1	JAIN, MONICA MD	7/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130820	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
49820	Fee-for-Service	1013353671	1013353671	1	1	JACKLEN JAMEL KHURI	10/4/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21641 CANADA ROAD	#19-E	LAKE FORREST	CA	92630	2757	30	06059	33.64946812	-117.6820497	Orange County
49868	Fee-for-Service	1932490745	1932490745	1	1	JAFFE, SHELLY S LCSW	12/12/2017	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
49896	Fee-for-Service	1124420609	1124420609	1	1	JAGTIANI, ANIL MD	12/19/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	131659	77	Infectious Disease	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
49933	Fee-for-Service	1972684645	1972684645	1	1	JHA, RITESH MD	8/10/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	111725	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
49983	Fee-for-Service	1659697654	1659697654	1	1	JIN, DANIEL H MD	2/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120252	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
50078	Fee-for-Service	1306498373	1306498373	1	1	JOHN PAUL II MEDICAL CLINIC	12/30/2021	213EG0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	INC	6529 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4208	19	06037	33.97991211	-118.2226508	Los Angeles County
50096	Fee-for-Service	1689722563	1689722563	1	1	JABLOW, JAY T	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	9867	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
50110	Fee-for-Service	1013353671	1013353671	1	1	JACKLEN JAMEL KHURI	10/4/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21641 CANADA ROAD	#19-E	LAKE FORREST	CA	92630	2757	30	06059	33.64946812	-117.6820497	Orange County
50134	Fee-for-Service	1659359586	1659359586	1	1	JOSAFAT, ALICE B MD	2/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	178470	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
50165	Fee-for-Service	1043225469	1043225469	1	1	JOEL BRAKE MD	2/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3819 STEPHENS AVE	STE 200	MISSOULA	MT	59801	8522	00	None	46.835955	-114.0137955	Missoula County
50185	Fee-for-Service	1124420609	1124420609	1	1	JAGTIANI, ANIL MD	12/19/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	131659	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
50221	Fee-for-Service	1972684645	1972684645	1	1	JHA, RITESH MD	8/10/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	111725	41	Internal Medicine	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
50341	Fee-for-Service	1174702377	1174702377	1	1	JEREMY IAN GROSSER, M.D., IN	9/27/2022	282N00000X	NA	Hospitals	026	PHYSICIANS	None	None	None	0	In state provider	C.	7836 RESEDA BLVD	None	RESEDA	CA	91335	1902	19	06037	34.21305947	-118.536035	Los Angeles County
50418	Fee-for-Service	1245593425	1245593425	1	1	JAN, TAHA A MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146049	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
50532	Fee-for-Service	1790960276	1790960276	1	1	JEKER-ANNAHEIM, SANDRA S	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	MD	505 PARNASSUS	BOX 0648	SAN FRANCISCO	CA	94122	0648	38	06075	37.76332993	-122.4582988	San Francisco County
50592	Fee-for-Service	1942815550	1942815550	1	1	JONES, ALYCIA S LCSW	9/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
50629	Fee-for-Service	1306818695	1306818695	1	1	JEFFREY R SCOTT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	499 E HAMPDEN AVE	STE 320	ENGLEWOOD	CO	80113	2793	00	None	39.65319046	-104.982129	Arapahoe County
50679	Fee-for-Service	1598843203	1598843203	1	1	JOBE, ROBERT B MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69000	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
50756	Fee-for-Service	1871919464	1871919464	1	1	JENBERIE, MARU M MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138851	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
50759	Fee-for-Service	1134111339	1134111339	1	1	JOHNSON,TIMOTHY A 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 CLINIC	200 HAWKINS DRIVE	None	IOWA	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
50786	Fee-for-Service	1730539321	1730539321	1	1	JOHNSON, GEINEL M LMFT	12/8/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
50788	Fee-for-Service	1821176983	1821176983	1	1	JACOBI, ALISON L MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62812	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
50852	Fee-for-Service	1134122922	1134122922	1	1	JOY, MIKI R MD	12/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38153	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
50877	Fee-for-Service	1144512781	1144512781	1	1	JENNIFER SUSAN VANWAGONER	5/10/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1134 RIMROCK DR	None	NAPA	CA	94558	9672	28	06055	38.5077176	-122.189109	Napa County
50975	Fee-for-Service	1174738801	1174738801	1	1	JONS OPTIQUE	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	114 W MAIN ST	STE D	VISALIA	CA	93291	6275	54	06107	36.330345	-119.2929345	Tulare County
51103	Fee-for-Service	1356720551	1356720551	1	1	JAVIER-DESLOGES, JUAN F MD	7/24/2020	208800000X	NA	Other	026	PHYSICIANS	167019	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
51146	Fee-for-Service	1689104911	1689104911	1	1	JESIONEK, ADAM MD	10/7/2019	390200000X	NA	Other	026	PHYSICIANS	158081	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
51189	Fee-for-Service	1982929329	1982929329	1	1	JOHNSON, JAMES A MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	21631	02	General Surgery	0	In state provider	None	12021 WILSHIRE BLVD	STE 745	LOS ANGELES	CA	90025	1206	19	06037	34.04543773	-118.4658404	Los Angeles County
51199	Fee-for-Service	1326278490	1326278490	1	5	JANESRI DE SILVA M.D. A PROF	4/3/2014	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	19	06037	34.137603	-118.101464	Los Angeles County
51252	Fee-for-Service	1356342950	1356342950	1	1	JANE GILBERT M.D.	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3585 BROADWAY AVE	None	NORTH BEND	OR	97459	1251	00	None	43.38941853	-124.2393222	Coos County
51304	Fee-for-Service	1720032980	1720032980	1	1	JOAQUIN, ARNEL M MD	9/18/1997	174400000X	NA	Other	026	PHYSICIANS	51799	41	Internal Medicine	0	In state provider	None	1220 E AVENUE S	STE G	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
51309	Fee-for-Service	1932869286	1932869286	1	1	JOHNSON, KRISTINA R CNP	2/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8831 VILLA LA JOLLA DR	None	LA JOLLA	CA	92037	1949	37	06073	32.869242	-117.230535	San Diego County
51339	Fee-for-Service	1164593802	1164593802	1	1	JADALI, DARYOUSH MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	48921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	184 N BRENT ST	None	VENTURA	CA	93003	2833	56	06111	34.27474874	-119.2572658	Ventura County
51427	Fee-for-Service	1750623823	1750623823	1	1	JIANG, SHIRLEY L MD	4/1/2019	207R00000X	NA	Other	026	PHYSICIANS	157077	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
51463	Fee-for-Service	1689107823	1689107823	1	1	JANG, GENE E MD	10/6/2021	390200000X	NA	Other	026	PHYSICIANS	159718	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
51465	Fee-for-Service	1780647875	1780647875	1	1	JACOBS, SCOTT E MD	2/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
51471	Fee-for-Service	1043500358	1043500358	1	1	JAHROMI, REBECCA NP	12/30/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
51488	Fee-for-Service	1851602189	1851602189	1	2	JULIUS IRUMUNDOMON	9/14/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4201 LONG BEACH BLVD	SUITE 308	LONG BEACH	CA	90807	2021	19	06037	33.83493255	-118.1895197	Los Angeles County
51499	Fee-for-Service	1831508423	1831508423	1	1	JUBAN, MELODY NP	3/27/2018	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
51541	Fee-for-Service	1548687924	1548687924	1	1	JENKINS, CECILY W PHD	3/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
51586	Fee-for-Service	1346440872	1346440872	1	1	JOHNSON, RONALD B	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
51592	Fee-for-Service	1720032980	1720032980	1	1	JOAQUIN, ARNEL M MD	9/18/1997	174400000X	NA	Other	026	PHYSICIANS	51799	38	Geriatrics	0	In state provider	None	1220 E AVENUE S	STE G	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
51628	Fee-for-Service	1538204326	1538204326	1	1	JACOBS, GARY OD	1/31/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 ESPLANADE DR	STE 560	OXNARD	CA	93036	0222	56	06111	34.23265069	-119.1766875	Ventura County
51636	Fee-for-Service	1053755785	1053755785	1	1	JERMANUS, SURA MD	2/28/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
51646	Fee-for-Service	1255494159	1255494159	1	1	JOE, STANTON H MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	22872	30	Radiology	0	In state provider	None	1500 S CENTRAL AVE	STE 116	GLENDALE	CA	91204	2586	19	06037	34.12736888	-118.257777	Los Angeles County
51677	Fee-for-Service	1720102510	1720102510	1	1	JONES, BERNARD P CRNA	7/21/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	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
51683	Fee-for-Service	1346222197	1346222197	1	1	JHAWAR, SANJAY MD	10/6/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73224	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
51735	Fee-for-Service	1699382267	1699382267	1	1	JUNO HEALTHCARE INC	10/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	621 E CARNEGIE DR	STE 190	SAN BERNARDINO	CA	92408	3511	36	06071	34.06953011	-117.2716769	San Bernardino County
51770	Fee-for-Service	1598389363	1598389363	1	1	JAMES C HO M.D. MEDICAL CORP	8/28/2020	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ORATION	1330 SAN BERNARDINO RD	SUITE G	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
51812	Fee-for-Service	1174076681	1174076681	1	1	JIMENEZ, MYRON OD	9/11/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1730 PRAIRIE CITY RD	STE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
51853	Fee-for-Service	1811158256	1811158256	1	1	JACOB HODGE M.D.	8/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
51965	Fee-for-Service	1710633565	1710633565	1	1	JUDGE, MIRANDA PT	3/25/2022	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
51998	Fee-for-Service	1770926743	1770926743	1	1	JOSEPH CAPERNA M.D., A PROFE	3/24/2014	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	49951	77	Infectious Disease	0	In state provider	SSIONAL CORPORATION	2333 1ST AVE	STE 104	SAN DIEGO	CA	92101	1538	37	06073	32.72984737	-117.1639109	San Diego County
52022	Fee-for-Service	1699382267	1699382267	1	1	JUNO HEALTHCARE INC	10/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	621 E CARNEGIE DR	STE 190	SAN BERNARDINO	CA	92408	3511	36	06071	34.06953011	-117.2716769	San Bernardino County
52041	Fee-for-Service	1093123069	1093123069	1	1	JOHNSON, COURTNY D DPM	8/24/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
52083	Fee-for-Service	1235662826	1235662826	1	1	JAVED, MARYHA I MD	11/14/2023	208M00000X	NA	Other	026	PHYSICIANS	179294	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
52093	Fee-for-Service	1811992670	1811992670	1	1	JANET MENDEL HARTVING	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	VANCOUVER RADIOLOGISTS	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
52095	Fee-for-Service	1942493499	1942493499	1	1	JACOBS, JAMES A	4/1/2002	246XS1301X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	SPECTRUM HEALTHCARE	21812 MIDCREST DR	None	LAKE FOREST	CA	92630	6587	30	06059	33.6463006	-117.6725193	Orange County
52202	Fee-for-Service	1811221641	1811221641	1	1	JACOBS KLEISLI, MILAGROS J	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11985	40	Pediatrics	0	In state provider	DO	250 E CHASE AVE	STE 108	EL CAJON	CA	92020	6305	37	06073	32.78042748	-116.9591715	San Diego County
52282	Fee-for-Service	1811432867	1811432867	1	1	JOSAN, KIRANBIR MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140714	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52287	Fee-for-Service	1770926743	1770926743	1	1	JOSEPH CAPERNA M.D., A PROFE	3/24/2014	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	49951	41	Internal Medicine	0	In state provider	SSIONAL CORPORATION	2333 1ST AVE	STE 104	SAN DIEGO	CA	92101	1538	37	06073	32.72984737	-117.1639109	San Diego County
52296	Fee-for-Service	1164505988	1164505988	1	1	JONATHAN G NEWMAN, 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	327 MEDICAL PARK DR	None	BRIDGEPORT	WV	26330	9006	00	None	39.32841314	-80.23814041	Harrison County
52508	Fee-for-Service	1922749613	1922749613	1	1	JIMENEZ, YILENA B MD	4/17/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	190004	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
52569	Fee-for-Service	1225104599	1225104599	1	1	JOHN TYLER THIESING	2/5/2019	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
52570	Fee-for-Service	1811432867	1811432867	1	1	JOSAN, KIRANBIR MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140714	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
52572	Fee-for-Service	1417158171	1417158171	1	1	JHANS, ALKA G MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124022	40	Pediatrics	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
52574	Fee-for-Service	1770926743	1770926743	1	1	JOSEPH CAPERNA M.D., A PROFE	3/24/2014	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	49951	68	Hematology	0	In state provider	SSIONAL CORPORATION	2333 1ST AVE	STE 104	SAN DIEGO	CA	92101	1538	37	06073	32.72984737	-117.1639109	San Diego County
52606	Fee-for-Service	1801248067	1801248067	1	1	JOO, RYAN H MD INC	1/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	114398	None	None	0	In state provider	None	959 E WALNUT ST	SUITE 120	PASADENA	CA	91106	5364	19	06037	34.14962102	-118.1305187	Los Angeles County
52635	Fee-for-Service	1225460264	1225460264	1	1	JAMBOOR MEDICAL CORPORATION	9/5/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11883 AMETHYST RD	None	VICTORVILLE	CA	92392	9225	36	06071	34.466292	-117.3643015	San Bernardino County
52669	Fee-for-Service	1952565525	1952565525	1	1	JUN, JASON J MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120840	18	Ophthalmology	0	In state provider	None	200 STEIN PLZ	RM 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
52676	Fee-for-Service	1184840621	1184840621	1	1	JAMES FOXE MD & WILLIAM	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	JM ROACH MD	1860 S CENTRAL ST	STE D	VISALIA	CA	93277	4418	54	06107	36.314469	-119.3106195	Tulare County
52737	Fee-for-Service	1932114618	1932114618	1	1	JARED PETRICK	9/5/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
52739	Fee-for-Service	1164051496	1164051496	1	1	JIANG, DANIEL MD	2/4/2025	208800000X	NA	Other	026	PHYSICIANS	187210	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
52751	Fee-for-Service	1740470319	1740470319	1	1	JAVDANFAR, SHAHRAM MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108346	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
52752	Fee-for-Service	1740258748	1740258748	1	1	JACQUES, ANNE T MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52898	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
52786	Fee-for-Service	1194290692	1194290692	1	1	JAEGER, ADELLA J LMFT	11/2/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12087 LOPEZ CANYON RD	STE 128	SYLMAR	CA	91342	6063	19	06037	34.292754	-118.40463	Los Angeles County
52934	Fee-for-Service	1518084763	1518084763	1	1	JOHNSON, JOY M MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	18824	30	Radiology	0	In state provider	None	1603 N BROADWAY	None	SANTA ANA	CA	92706	3908	30	06059	33.75906711	-117.8696079	Orange County
52966	Fee-for-Service	1063597722	1063597722	1	1	JANAVS, JINA L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80293	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
52985	Fee-for-Service	1598124893	1598124893	1	1	JOHNSON, BRIDGET C PHD	1/14/2021	103G00000X	NA	Other	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
53011	Fee-for-Service	1568406692	1568406692	1	1	JONES, GREGORY 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	630 ADDISON AVE W	STE 100	TWIN FALLS	ID	83301	5475	00	None	42.56415243	-114.4940357	Twin Falls County
53081	Fee-for-Service	1922603018	1922603018	1	1	J&J MEDICAL SUPPLY LLC.	3/31/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	1025	NORWALK	CA	90650	4369	19	06037	33.90523023	-118.0681168	Los Angeles County
53097	Fee-for-Service	1992882179	1992882179	1	1	JACKSON, HAROLD G MD	7/31/1989	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	46367	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
53188	Fee-for-Service	1578786091	1578786091	1	1	JOHN C FREMONT MED CLN	9/9/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
53252	Fee-for-Service	1366806879	1366806879	1	1	JACQUEZ, IMMANUEL	9/1/2023	207L00000X	NA	Other	026	PHYSICIANS	184944	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
53280	Fee-for-Service	1659711257	1659711257	1	1	JOE, ELIZABETH B MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134690	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
53348	Fee-for-Service	1790909679	1790909679	1	1	JOHNSON, KELLI A MD	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93104	None	None	0	In state provider	None	710 LAWERENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
53390	Fee-for-Service	1548205719	1548205719	1	1	JONES, MICHAEL A LCSW	1/28/2008	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1835 EL CAJON BLVD	STE A	SAN DIEGO	CA	92103	2591	37	06073	32.75515551	-117.1453277	San Diego County
53401	Fee-for-Service	1760572655	1760572655	1	1	JIMENEZ, NATHALIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDREN'S UNIV MED GRP	4500 SAND POINT WAY NE,	#100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
53457	Fee-for-Service	1639176415	1639176415	1	2	JANTOS, THOMAS J MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62096	01	General 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
53465	Fee-for-Service	1376963033	1376963033	1	1	JOUKAR, MEHRDAD LAC	7/30/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	411 N CENTRAL AVE	610	GLENDALE	CA	91203	2081	19	06037	34.15248444	-118.2579448	Los Angeles County
53475	Fee-for-Service	1578786091	1578786091	1	1	JOHN C FREMONT MED CLN	9/9/1992	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
53490	Fee-for-Service	1114940988	1114940988	1	1	JENNICHES, STEPHANIE D NP	3/3/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53541	Fee-for-Service	1003879545	1003879545	1	1	JAMES B BOSSORT MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	715 E BROADWAY AVE	None	BISMARCK	ND	58501	4451	00	None	46.80603	-100.78074	Burleigh County
53615	Fee-for-Service	1336105386	1336105386	1	1	JOHNSTON, MICKAILA J MD	4/3/2023	207U00000X	NA	Other	026	PHYSICIANS	134841	None	None	0	In state provider	None	1955 CITRACADO PKWY	STE 100	ESCONDIDO	CA	92029	4158	37	06073	33.11301099	-117.1202081	San Diego County
53724	Fee-for-Service	1144401001	1144401001	1	1	JONBEC CARE, INC	1/11/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SALISBURY HOUSE	13131 6TH PL	None	YUCAIPA	CA	92399	2345	36	06071	34.01475809	-117.0624832	San Bernardino County
53743	Fee-for-Service	1639176415	1639176415	1	2	JANTOS, THOMAS J MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62096	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
53780	Fee-for-Service	1699110460	1699110460	1	1	JEAN T KOCH	8/1/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	200 IRONSTONE COURT	None	ROSEVILLE	CA	95747	5840	31	06061	38.76884866	-121.3258181	Placer County
53796	Fee-for-Service	1801121876	1801121876	1	1	JOONG WON ACUPUNCTURE & HERB	11/18/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	AL MEDICINE, INC.	18 ENDEAVOR	205	IRVINE	CA	92618	3181	30	06059	33.6675519	-117.7622659	Orange County
53801	Fee-for-Service	1043506140	1043506140	1	1	JOBA, AMEHA T DPM	10/3/2016	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	442 SUNSET BLVD	None	HAYWARD	CA	94541	6296	01	06001	37.67421974	-122.0975231	Alameda County
53989	Fee-for-Service	1699823401	1699823401	1	1	JONG, DONALD K MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55017	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
54066	Fee-for-Service	1699110460	1699110460	1	1	JEAN T KOCH	8/1/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	200 IRONSTONE COURT	None	ROSEVILLE	CA	95747	5840	31	06061	38.76884866	-121.3258181	Placer County
54137	Fee-for-Service	1457653172	1457653172	1	1	JIMENEZ, ARTURO LCSW	2/6/2020	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
54179	Fee-for-Service	1609132067	1609132067	1	1	JAY S RAJU MD INC	3/5/1979	174400000X	NA	Other	026	PHYSICIANS	33552	41	Internal Medicine	0	In state provider	None	2030 FOREST AVE	100	SAN JOSE	CA	95128	4833	43	06085	37.32706467	-121.9341193	Santa Clara County
54248	Fee-for-Service	1992872766	1992872766	1	1	JONES, KAREN E NP	9/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1188 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.850314	-117.9416115	Orange County
54298	Fee-for-Service	1538481643	1538481643	1	1	JIMENEZ JONES, ROSE A LPCC	7/23/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
54299	Fee-for-Service	1720475270	1720475270	1	1	JUNG, JAMES S MD	11/10/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	145200	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
54434	Fee-for-Service	1821058470	1821058470	1	1	JEEREDDI, PRASAD A MD	10/13/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32129	None	None	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
54467	Fee-for-Service	1609132067	1609132067	1	1	JAY S RAJU MD INC	3/5/1979	174400000X	NA	Other	026	PHYSICIANS	33552	10	Gastroenterology (M.D. only)	0	In state provider	None	2030 FOREST AVE	100	SAN JOSE	CA	95128	4833	43	06085	37.32706467	-121.9341193	Santa Clara County
54534	Fee-for-Service	1952342883	1952342883	1	1	JABOLA, R MARVIN MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	60059	30	Radiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
54703	Fee-for-Service	1376660597	1376660597	1	1	JASON WINEBARGER	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2115 NE WYATT CT	STE 201	BEND	OR	97701	7680	00	None	44.07196465	-121.2649558	Deschutes County
54809	Fee-for-Service	1013058692	1013058692	1	1	JONBEC HOUSE	1/10/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1334 LANFAIR ST	None	REDLANDS	CA	92374	2633	36	06071	34.07192184	-117.1678384	San Bernardino County
54961	Fee-for-Service	1376644989	1376644989	1	1	JENNINGS, DANA N MD	1/20/2009	207R00000X	NA	Other	026	PHYSICIANS	105534	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
54994	Fee-for-Service	1033114178	1033114178	1	1	JUPINA, DAVID J MD	4/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77706	20	Orthopedic Surgery	0	In state provider	None	5601 NORRIS CANYON RD	STE 130A	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
55079	Fee-for-Service	1609964261	1609964261	1	1	JAKUBOWSKI, ALAN P MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	85336	25	Physical Medicine and Rehabilitation	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
55174	Fee-for-Service	1821090697	1821090697	1	1	JACKSON, JEFFREY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SUGAR LAND NEUROLOGY	16659 SOUTHWEST FRWY,	STE 131	SUGAR LAND	TX	77479	0000	00	None	29.588265	-95.630949	Fort Bend County
55183	Fee-for-Service	1053349860	1053349860	1	1	JEFFREY WATKINS M.D.	6/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
55190	Fee-for-Service	1629690334	1629690334	1	1	JONES, CARRISSA M LMFT	1/15/2025	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
55197	Fee-for-Service	1841685005	1841685005	1	1	JONES, STEPHANIE A MD	3/2/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
55252	Fee-for-Service	1306065552	1306065552	1	1	JOHNSON, JAMEY L CRNA	9/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
55296	Fee-for-Service	1750745493	1750745493	1	1	JI, AMANDA R MD	9/14/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169342	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
55345	Fee-for-Service	1487933776	1487933776	1	1	JASMIN, JENNIFER LMFT	9/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
55352	Fee-for-Service	1649482845	1649482845	1	1	JAIRAM-THODLA, ARATI 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
55367	Fee-for-Service	1457300477	1457300477	1	1	JOHNSON, JACOB MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65871	04	Otology, Laryngology, Rhinology	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
55386	Fee-for-Service	1790219202	1790219202	1	1	JEFFREY SAKAMOTO M.D.	11/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
55433	Fee-for-Service	1073743019	1073743019	1	1	JASON R FLETCHER, 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	3500 W WHEATLAND RD	None	DALLAS	TX	75237	3460	00	None	32.64745255	-96.8764365	Dallas County
55480	Fee-for-Service	1730114067	1730114067	1	1	JACOBS, THOMAS A DPM	12/26/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	29	06057	39.23512508	-121.0306878	Nevada County
55522	Fee-for-Service	1831929298	1831929298	1	1	JACKSON, AMBER PT	2/18/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B ST	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
55576	Fee-for-Service	1083992713	1083992713	1	1	JALOTA, LEENA MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131122	41	Internal Medicine	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
55614	Fee-for-Service	1144894239	1144894239	1	1	JEAN ELIZABETH NJOKI MUNYIRI	5/25/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6343 KEYSTONE WAY	None	FONTANA	CA	92336	4054	36	06071	34.13874432	-117.4740981	San Bernardino County
55615	Fee-for-Service	1649450461	1649450461	1	1	JAMIE PRICE MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
55625	Fee-for-Service	1760562037	1760562037	1	1	JAIN, AMITA MD	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66678	40	Pediatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 202	DALY CITY	CA	94015	2222	41	06081	37.68077723	-122.4728941	San Mateo County
55634	Fee-for-Service	1396847273	1396847273	1	1	JUSTER, ROBYN S MD	12/31/1991	207P00000X	NA	Other	026	PHYSICIANS	69344	66	Emergency Medicine (Urgent Care)	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
55677	Fee-for-Service	1720696180	1720696180	1	1	JEWEL HOMECARE LLC	1/27/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	20152 RIVERSIDE DR	None	NEWPORT BEACH	CA	92660	1325	30	06059	33.6632485	-117.8815123	Orange County
55749	Fee-for-Service	1235313867	1235313867	1	1	JOLLEY, JENNIFER A MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94556	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
55757	Fee-for-Service	1780720979	1780720979	1	1	JOHNSON, KENDRICK M MD	6/7/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83104	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
55762	Fee-for-Service	1689726044	1689726044	1	1	JAVAHERIAN, AFSHIN MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90469	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
55843	Fee-for-Service	1245618883	1245618883	1	1	JOSEPH, JENNIFER L	11/4/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
55893	Fee-for-Service	1528341039	1528341039	1	1	JOHNSON, MICHAELA R 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
55898	Fee-for-Service	1447463229	1447463229	1	1	JAMES, ELLEN A NP	5/15/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
55899	Fee-for-Service	1144894239	1144894239	1	1	JEAN ELIZABETH NJOKI MUNYIRI	5/25/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6343 KEYSTONE WAY	None	FONTANA	CA	92336	4054	36	06071	34.13874432	-117.4740981	San Bernardino County
55932	Fee-for-Service	1841508520	1841508520	1	1	JONES, JUDITH D MD	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82166	08	Family Practice	0	In state provider	None	1580 VALENCIA ST	STE 802	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
55941	Fee-for-Service	1386777498	1386777498	2	1	J.I MEDICAL INC,	9/29/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5812 W. PICO BLVD	SUITE A	LOS ANGELES	CA	90019	0001	19	06037	34.05117402	-118.3650641	Los Angeles County
56095	Fee-for-Service	1386871515	1386871515	1	2	JOHNSON, GEORGE E	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	29754	None	None	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
56102	Fee-for-Service	1194036293	1194036293	1	1	JAN, AMANDA I MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126169	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
56150	Fee-for-Service	1003567553	1003567553	1	1	JIMENEZ, KELLY	8/6/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
56170	Fee-for-Service	1720485287	1720485287	1	1	JETT, MEGAN	2/13/2025	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	765 MEDICAL CENTER CT	SUITE 203	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
56199	Fee-for-Service	1255396461	1255396461	1	2	JOHN C PACK OD & BEVERLY	11/21/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BIANES OF TERRA NOVA VIS	890 EASTLAKE PARKWAY	STE 102	CHULA VISTA	CA	91914	4521	37	06073	32.65223126	-116.9677279	San Diego County
56219	Fee-for-Service	1841508520	1841508520	1	1	JONES, JUDITH D MD	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82166	01	General Practice	0	In state provider	None	1580 VALENCIA ST	STE 802	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
56224	Fee-for-Service	1588173884	1588173884	1	1	JOY HOME HEALTH CARE INC	1/20/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13455 VENTURA BLVD	STE 303	SHERMAN OAKS	CA	91423	3830	19	06037	34.1472989	-118.426769	Los Angeles County
56277	Fee-for-Service	1851773204	1851773204	1	1	JOSHUA I WESTBROOK	7/27/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1836 SOUTH AVE	None	LA CROSSE	WI	54601	5429	00	None	43.79526216	-91.24709055	La Crosse County
56343	Fee-for-Service	1881031177	1881031177	1	1	JOHNSTON, TYLER R MD	4/1/2020	390200000X	NA	Other	026	PHYSICIANS	131701	20	Orthopedic Surgery	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56369	Fee-for-Service	1326026436	1326026436	1	1	JANET V HAYS MD	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
56393	Fee-for-Service	1811915085	1811915085	1	1	JOHNSON, LEIGHTON C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86745	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
56469	Fee-for-Service	1619992286	1619992286	1	1	JACKSON, CHRISTY M MD	7/1/1993	2084N0400X	NA	Neurology	026	PHYSICIANS	52151	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
56481	Fee-for-Service	1528016318	1528016318	1	1	JACOUB, JACK F MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79623	78	Neoplastic Diseases/Oncology	0	In state provider	None	9940 TALBERT AVE	STE 100	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
56568	Fee-for-Service	1124515119	1124515119	1	6	JEFFREY BROOKS MD INC	7/2/2023	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6939 SUNRISE BLVD	STE 119	CITRUS HEIGHTS	CA	95610	3153	34	06067	38.692602	-121.2731145	Sacramento County
56640	Fee-for-Service	1023188943	1023188943	2	1	JENNINGS ORTHOPEDIC INC	6/16/2021	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	10683 MAGNOLIA AVE	SUITE A	RIVERSIDE	CA	92505	1893	33	06065	33.90827892	-117.4680748	Riverside County
56771	Fee-for-Service	1528016318	1528016318	1	1	JACOUB, JACK F MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79623	68	Hematology	0	In state provider	None	9940 TALBERT AVE	STE 100	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
56791	Fee-for-Service	1669659744	1669659744	1	1	JEELANI, JAFER M MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103142	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
57020	Fee-for-Service	1063999175	1063999175	1	1	JOHNSON, CLAYTON J MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2101 GLENOAKS BLVD	None	BURBANK	CA	91504	0000	19	06037	34.19790492	-118.3264418	Los Angeles County
57045	Fee-for-Service	1699152058	1699152058	1	1	JOON CHOI, MD. APC	3/14/2025	207V00000X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8215 VAN NUYS BLVD	SUITE 104	PANORAMA CITY	CA	91402	4810	19	06037	34.22026244	-118.4488066	Los Angeles County
57134	Fee-for-Service	1518036821	1518036821	1	2	JUSTINO, HENRI MD	7/27/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	173773	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
57251	Fee-for-Service	1134445216	1134445216	1	1	JOHNSON, CLARE A MD	2/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134295	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
57305	Fee-for-Service	1467698811	1467698811	1	1	JUBB, SONYA M CNM	12/9/2021	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
57334	Fee-for-Service	1699152058	1699152058	1	1	JOON CHOI, MD. APC	1/5/2021	207V00000X	NA	Obstetrics & Gynecology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	8215 VAN NUYS BLVD	SUITE 104	PANORAMA CITY	CA	91402	4810	19	06037	34.22026244	-118.4488066	Los Angeles County
57344	Fee-for-Service	1467970889	1467970889	1	1	JIMENEZ, ELIZABETH LCSW	3/2/2022	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
57354	Fee-for-Service	1326170192	1326170192	1	1	JENNINGS, ERIKA LMFT	4/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
57370	Fee-for-Service	1194161190	1194161190	1	1	JASON CROOK	10/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 S PIONEER PKWY	None	SALT LAKE CTY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
57413	Fee-for-Service	1619041936	1619041936	1	1	JIMENEZ, LOURDES C MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64658	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
57473	Fee-for-Service	1306320148	1306320148	1	1	JADALLAH, PRISCILLA LMFT	11/10/2022	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
57531	Fee-for-Service	1952477465	1952477465	1	1	JUAREZ, ROBERT JR	3/18/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
57598	Fee-for-Service	1689693517	1689693517	1	1	JAMES, PATRICIA L MD	10/19/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	34409	01	General Practice	0	In state provider	None	39600 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3265	33	06065	33.7614267	-116.4080191	Riverside County
57606	Fee-for-Service	1184771073	1184771073	1	1	JACKSON, TAMARA MD	6/10/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
57622	Fee-for-Service	1699152058	1699152058	1	1	JOON CHOI, MD. APC	10/3/2017	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8215 VAN NUYS BLVD	SUITE 104	PANORAMA CITY	CA	91402	4810	19	06037	34.22026244	-118.4488066	Los Angeles County
57638	Fee-for-Service	1285712380	1285712380	1	1	JANSEN, CORNELIUS MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85048	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
57679	Fee-for-Service	1841245057	1841245057	1	1	JOHNSON, RANDALL L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34657	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
57712	Fee-for-Service	1750455259	1750455259	1	2	JACOBS, STEVEN J MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	45704	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
57786	Fee-for-Service	1720247505	1720247505	1	1	JOSHUA KLESS KERN, 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
57789	Fee-for-Service	1821070459	1821070459	1	2	JORDAN, TAMIKO A MD	5/1/2013	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	376 PALOMARES AVE	None	VENTURA	CA	93003	1737	56	06111	34.28064586	-119.2452271	Ventura County
57805	Fee-for-Service	1932606431	1932606431	1	1	JOHN, LITTY MD	10/18/2023	207L00000X	NA	Other	026	PHYSICIANS	191306	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
57823	Fee-for-Service	1154858850	1154858850	1	1	JIMENEZ, SAMANTHA S MD	3/5/2025	2080P0205X	NA	Endocrinology	026	PHYSICIANS	173020	67	Endocrinology	0	In state provider	None	3814 AUBURN BLVD	72	SACRAMENTO	CA	95821	2123	34	06067	38.639034	-121.375305	Sacramento County
57965	Fee-for-Service	1841245057	1841245057	1	1	JOHNSON, RANDALL L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34657	08	Family Practice	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
57985	Fee-for-Service	1174835003	1174835003	1	1	JOLEPALEM, PRASHANT MD	5/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169326	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
58009	Fee-for-Service	1699854349	1699854349	1	1	JAIN, MEENAKSHI MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83961	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
58068	Fee-for-Service	1770658841	1770658841	1	1	JOELSON, E M MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62234	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
58104	Fee-for-Service	1588193270	1588193270	1	1	JAHROMI, BEHDAD MD	10/10/2023	207L00000X	NA	Other	026	PHYSICIANS	186203	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
58108	Fee-for-Service	1154858850	1154858850	1	1	JIMENEZ, SAMANTHA S MD	3/5/2025	2080P0205X	NA	Endocrinology	026	PHYSICIANS	173020	40	Pediatrics	0	In state provider	None	3814 AUBURN BLVD	72	SACRAMENTO	CA	95821	2123	34	06067	38.639034	-121.375305	Sacramento County
58214	Fee-for-Service	1174662787	1174662787	1	1	JONBEC CARE, INC	12/1/1996	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1695 ROSENA AVE	None	LOMA LINDA	CA	92354	1745	36	06071	34.07020899	-117.2458734	San Bernardino County
58339	Fee-for-Service	1639199268	1639199268	1	1	JIAO, DANIEL W Y LAC	8/2/2017	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2203	43	06085	37.43920432	-122.162109	Santa Clara County
58367	Fee-for-Service	1508966011	1508966011	1	1	JOHN E LOOBY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RAPID CITY REGIONAL HOSP	353 FAIRMONT BLVD	None	RAPID CITY	SD	55701	7375	00	None	44.05854729	-103.2246985	Pennington County
58370	Fee-for-Service	1730287913	1730287913	1	1	JULIE RILEY, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
58383	Fee-for-Service	1477665693	1477665693	1	1	JONES, DAVID B MD	8/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81751	20	Orthopedic Surgery	0	In state provider	None	2510 AIRPARK DRIVE	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
58483	Fee-for-Service	1407290745	1407290745	1	1	JOH, JAE W MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142184	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
58501	Fee-for-Service	1972992071	1972992071	1	1	JANSEN, KATHLEEN E MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
58626	Fee-for-Service	1104136126	1104136126	1	1	JACKSON MEDICAL SUPPLY INC	5/5/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	604 MAIN ST	None	WOODLAND	CA	95695	3405	57	06113	38.67743314	-121.7728635	Yolo County
58675	Fee-for-Service	1437900073	1437900073	1	1	JACOBY, BRIGIT S LCSW	4/29/2024	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
58760	Fee-for-Service	1043730377	1043730377	1	2	JEFFERSON SHIELDS, MONIK NP	1/14/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
58770	Fee-for-Service	1023009081	1023009081	1	1	JASON RICHTER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HEALTHONE CLINIC SERVICE	700 POTAMAC ST	None	AURORA	CO	80011	0000	00	None	39.728142	-104.8269195	Arapahoe County
58772	Fee-for-Service	1689887051	1689887051	1	1	JONES NCUBE, KENDRA G MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92088	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
58825	Fee-for-Service	1396202768	1396202768	1	1	JANG, JINA PHD	8/12/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
58875	Fee-for-Service	1922710169	1922710169	1	1	JOHNSON, LASHELLE NP	9/21/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
58927	Fee-for-Service	1609277136	1609277136	1	1	JUSTICE, MARA B PSYD	5/20/2024	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
58975	Fee-for-Service	1679069710	1679069710	1	1	JOHNSTON, KATIA MD	7/2/2022	207P00000X	NA	Other	026	PHYSICIANS	176990	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
59020	Fee-for-Service	1740535608	1740535608	1	1	JAIN, SHIV M MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139100	01	General Practice	0	In state provider	None	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1442	43	06085	37.39572142	-122.1051204	Santa Clara County
59061	Fee-for-Service	1811197908	1811197908	1	1	JOHNSTON, KATHERINE G MD	11/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104412	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
59095	Fee-for-Service	1093267163	1093267163	1	1	JOHNSON, VERONICA A LPCC	7/30/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
59227	Fee-for-Service	1841883279	1841883279	1	1	JEFFREY S SAGER MD MEDICAL C	5/4/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	None	None	0	In state provider	ORPORATION	2428 CASTILLO ST STE D	None	SANTA BARBARA	CA	93105	5311	42	06083	34.43125837	-119.7251788	Santa Barbara County
59233	Fee-for-Service	1780732743	1780732743	1	1	JANG, FRANCIS W MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55011	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
59283	Fee-for-Service	1447648324	1447648324	1	1	JUAREZ, ERIC A LCSW	12/3/2019	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
59346	Fee-for-Service	1104901859	1104901859	1	1	JUNDT, DANA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742164	-104.8350375	Adams County
59397	Fee-for-Service	1255302444	1255302444	1	1	JANNELLI,CHRIS 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	2700 STEWART PARKWAY	None	ROSEBURG	OR	97471	1281	00	None	43.2399838	-123.3665048	Douglas County
59452	Fee-for-Service	1023426228	1023426228	1	1	JACKSON-YOUNG, DAVETTA LMFT	1/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	343 E MAIN ST	STE 400	STOCKTON	CA	95202	3057	39	06077	37.95334019	-121.2862084	San Joaquin County
59530	Fee-for-Service	1114366192	1114366192	1	1	JOLICOEUR, MEGAN MD	5/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16780	08	Family Practice	0	In state provider	None	2020 SANTA MONICA BLVD	SUITE 600	SANTA MONICA	CA	90404	2131	19	06037	34.02901811	-118.4795396	Los Angeles County
59670	Fee-for-Service	1619060134	1619060134	1	1	JACKSON, JAMES M MD	5/1/1994	174400000X	NA	Other	026	PHYSICIANS	74843	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
59688	Fee-for-Service	1649619941	1649619941	1	1	JENSEN, AMANDA R MD	3/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	181980	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59717	Fee-for-Service	1417081274	1417081274	1	2	JAFFE, MICHAEL P MD	4/3/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	88623	-	NOT APPLICABLE	0	In state provider	None	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
59742	Fee-for-Service	1285058511	1285058511	1	1	JOHNSON, ERIC S LMFT	6/21/2024	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
59760	Fee-for-Service	1619269958	1619269958	1	1	JOHNSON, BENJAMIN	6/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125703	30	Radiology	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
59787	Fee-for-Service	1881034569	1881034569	1	1	JAMIESON, STEPHEN W MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149318	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
59863	Fee-for-Service	1063421212	1063421212	1	1	JAMBOOR E JAYASHANKAR	8/5/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	12675 HESPERIA RD	None	VICTORVILLE	CA	92395	5878	36	06071	34.48143043	-117.2906246	San Bernardino County
59899	Fee-for-Service	1073623104	1073623104	1	1	JONATHAN O. SWANSON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
59949	Fee-for-Service	1275586265	1275586265	1	1	JONES, JOHN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 S BYRON BLVD	None	CHAMBERLAIN	SD	57325	9741	00	None	43.78529959	-99.32478053	Brule County
59953	Fee-for-Service	1912947995	1912947995	1	1	JACOBS, 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	8TH ANVEUE + C STREET	None	SALT LAKE CITY	UT	84143	0000	00	None	40.779063	-111.8805548	Salt Lake County
59955	Fee-for-Service	1851348486	1851348486	1	1	JSE EMERGENCY MEDICAL	2/17/2005	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	21530 PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
60013	Fee-for-Service	1851607253	1851607253	1	1	JAE, HYEJIN MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124121	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90602	1049	19	06037	33.94435533	-117.9931159	Los Angeles County
60031	Fee-for-Service	1124515119	1124515119	1	4	JEFFREY BROOKS MD INC	7/18/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1460 CAMINO ALTO	STE 101	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
60076	Fee-for-Service	1003895749	1003895749	1	1	JONATHAN PHILIP HORWITZ 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	2525 GLENN HENDREN DR	None	LIBERTY	MO	64068	9625	00	None	39.278767	-94.42102759	Clay County
60087	Fee-for-Service	1063693240	1063693240	1	1	JMAR HOMES, INC	8/20/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WHITE LANE HOME	5604 NICHOLAS STREET	None	BAKERSFIELD	CA	93304	7212	15	06029	35.303697	-119.022852	Kern County
60099	Fee-for-Service	1255388385	1255388385	1	1	JAYAWARDENA, KUMARI M MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81717	01	General Practice	0	In state provider	None	11000 OLSON DR	STE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
60111	Fee-for-Service	1649341553	1649341553	1	1	JAVOR, EDWARD D MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69216	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
60115	Fee-for-Service	1033296629	1033296629	1	1	JULKA, DILPREET P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55266	None	None	0	In state provider	None	3780 KILROY AIRPORT WAY	STE 115	LONG BEACH	CA	90806	2458	19	06037	33.80733529	-118.1450095	Los Angeles County
60129	Fee-for-Service	1184155186	1184155186	1	1	JUERGENS, NATHAN MD	11/8/2020	208M00000X	NA	Other	026	PHYSICIANS	157601	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
60135	Fee-for-Service	1780175190	1780175190	1	1	JUSTICE, KAITLIN S CNP	1/8/2020	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
60300	Fee-for-Service	1578092367	1578092367	1	1	JEON, HEE MD	2/4/2025	1835C0206X	NA	None	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2901 SILLECT AVE.	201	BAKERSFIELD	CA	93308	6373	15	06029	35.38611256	-119.0393796	Kern County
60316	Fee-for-Service	1962577692	1962577692	1	1	JASIK, CAROLYN B MD	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89172	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
60347	Fee-for-Service	1376581892	1376581892	1	1	JHANDIYA FAISAL Q 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 W.CAMPBELL RD	None	RICHARDSON	TX	75080	3416	00	None	32.97532651	-96.7266135	Dallas County
60349	Fee-for-Service	1225682347	1225682347	1	1	JACOB'S HEART CHILDREN'S CAN	9/15/2021	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CER SUPPORT SERVICES	680 W BEACH ST	None	WATSONVILLE	CA	95076	5140	44	06087	36.90502585	-121.7678571	Santa Cruz County
60398	Fee-for-Service	1649341553	1649341553	1	1	JAVOR, EDWARD D MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69216	67	Endocrinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
60403	Fee-for-Service	1669770574	1669770574	1	1	JOHNSTON, DUNCAN M MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140788	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
60409	Fee-for-Service	1467519504	1467519504	1	1	JACOBSON, CARRIE H	5/11/2007	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
60469	Fee-for-Service	1699988832	1699988832	1	1	JEREMY SMITH M.D.	11/10/2016	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
60494	Fee-for-Service	1679734354	1679734354	1	1	JOHN K BRADSHAW M.D.	3/16/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2925 RYAN DR SE	None	SALEM	OR	97301	9687	00	None	44.920224	-123.001551	Marion County
60507	Fee-for-Service	1811075443	1811075443	1	1	JERNIGAN, LAURA A MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72148	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
60534	Fee-for-Service	1275760043	1275760043	1	1	JEFFREY, JESSICA K MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116023	36	Psychiatry	0	In state provider	None	11318 NATIONAL BLVD	None	LOS ANGELES	CA	96006	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
60537	Fee-for-Service	1609171982	1609171982	1	1	JARDON, JAVIER A MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131365	18	Ophthalmology	0	In state provider	None	835 THIRD AVENUE	SUITE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
60570	Fee-for-Service	1508850843	1508850843	1	1	JOYO, GHULAM MD	2/27/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
60628	Fee-for-Service	1396015434	1396015434	1	1	JIH, LILY J MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103883	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	STE 8725	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
60774	Fee-for-Service	1023319332	1023319332	1	1	JIANG, JIE-GEN MD	5/18/2021	207ZP0102X	NA	Other	026	PHYSICIANS	90397	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
60775	Fee-for-Service	1295927390	1295927390	1	1	JAHNG, ALEXANDER W MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101800	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3460	36	06071	34.047153	-117.2611485	San Bernardino County
60818	Fee-for-Service	1275760043	1275760043	1	1	JEFFREY, JESSICA K MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116023	26	Psychiatry (child)	0	In state provider	None	11318 NATIONAL BLVD	None	LOS ANGELES	CA	96006	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
60839	Fee-for-Service	1023824661	1023824661	1	1	JOHNSON, KELLY PT	1/21/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25381 RAILROAD CANYON RD	1101 AND 1102	LAKE ELSINORE	CA	92532	2705	33	06065	33.66885662	-117.2636558	Riverside County
60880	Fee-for-Service	1891973806	1891973806	1	1	JAVED, TARIQ MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102388	41	Internal Medicine	0	In state provider	None	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1658	15	06029	35.392059	-119.010556	Kern County
60899	Fee-for-Service	1669422416	1669422416	2	1	JAMES HASENAUER	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
60914	Fee-for-Service	1992728992	1992728992	1	1	JAIN, BHARTI MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42548	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1800 MEDICAL CENTER DR	STE 200	SAN BERNARDINO	CA	92411	1242	36	06071	34.131816	-117.322587	San Bernardino County
61080	Fee-for-Service	1205929973	1205929973	1	1	JANI, ATUL N	4/10/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	72649	85	Surgery-Pediatric	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
61130	Fee-for-Service	1992916381	1992916381	1	1	JOHNSON, AMANDA L MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116503	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
61147	Fee-for-Service	1265685432	1265685432	1	1	JESSICA A.CARLSON MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2830 N WASHINGTON ST	None	BISMARCK	ND	58503	1482	00	None	46.8378	-100.7944155	Burleigh County
61296	Fee-for-Service	1992301063	1992301063	1	1	JUHL, RYAN C NP	3/1/2021	207Q00000X	NA	Adult Primary Care	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
61307	Fee-for-Service	1730493107	1730493107	1	1	JOGANI, PIYUSH K MD	9/23/2010	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	18250 ROSCOE BLVD	SUITE #310	NORTHRIDGE	CA	91325	4286	19	06037	34.22076142	-118.5313223	Los Angeles County
61315	Fee-for-Service	1548443872	1548443872	1	1	JERWERS, ALLISON B NP	12/27/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	SUITE 2800	None	SACRAMENTO	CA	95820	1536	34	06067	0	0	None
61323	Fee-for-Service	1659338788	1659338788	1	1	JANSSON, ERIK J MD	9/5/1973	207W00000X	NA	Ophthalmology	026	PHYSICIANS	35343	18	Ophthalmology	0	In state provider	None	3798 JANES RD	STE 16	ARCATA	CA	95521	4746	12	06023	40.89649119	-124.0930501	Humboldt County
61491	Fee-for-Service	1063587418	1063587418	1	1	JOY, AUBREY E PHD	3/18/2020	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1441 37TH ST	None	SACRAMENTO	CA	95816	6701	34	06067	38.565936	-121.4586045	Sacramento County
61506	Fee-for-Service	1992867618	1992867618	1	1	JOSE ARVIZU OLVERA	8/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
61686	Fee-for-Service	1619342516	1619342516	1	1	JOHNSON, LINDA L LMFT	8/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 1ST AVE	3	SAN MATEO	CA	94401	3213	41	06081	37.56829343	-122.32232	San Mateo County
61762	Fee-for-Service	1396083853	1396083853	1	1	JULIAN, JAMIE M MSW LCSW	3/8/2022	207RA0000X	NA	Pediatric Primary Care	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	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
61898	Fee-for-Service	1558661942	1558661942	1	2	JASMINE P. NGUYEN, O.D., INC	7/22/2020	261QH0100X	NA	Other	023	GROUP 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
61914	Fee-for-Service	1457731242	1457731242	1	1	JANDA, MAHAJAN & BALSIGER PL	10/11/2022	2084N0400X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
61921	Fee-for-Service	1407490493	1407490493	1	1	JOSEPH, KISAL M AU	3/7/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
61941	Fee-for-Service	1023697877	1023697877	1	1	J&S PEDIATRIC THERAPY, INC.	2/11/2025	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3660 CLAIREMONT DR,	STE 2	SAN DIEGO	CA	92117	5968	37	06073	32.80759429	-117.2010737	San Diego County
62001	Fee-for-Service	1891278966	1891278966	1	1	JIMENEZ, KRISTINA L	10/16/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	378 41ST STREET	None	BANNING	CA	92220	3048	33	06065	33.9288385	-116.9221354	Riverside County
62036	Fee-for-Service	1023507084	1023507084	1	1	JOUK, ALEXANDRA J PHD	9/18/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
62049	Fee-for-Service	1033194253	1033194253	1	1	JUN, AARON H MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81322	None	None	0	In state provider	None	3900 SHERMAN DR	STE K	RIVERSIDE	CA	92503	4005	33	06065	33.92756479	-117.4375031	Riverside County
62069	Fee-for-Service	1689291056	1689291056	1	1	JANG, KATIE OD	12/8/2022	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
62077	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	8/13/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
62118	Fee-for-Service	1699173922	1699173922	1	1	JAH HAND SURGERY	11/13/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	11093	20	Orthopedic Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 717	LOS ANGELES	CA	90017	4814	19	06037	34.05362775	-118.2661889	Los Angeles County
62154	Fee-for-Service	1285165084	1285165084	1	1	JORDAN, TIMOTHY M MD	5/14/2020	390200000X	NA	Other	026	PHYSICIANS	157600	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
62167	Fee-for-Service	1609187517	1609187517	1	1	JOHNSON, CHARLES MD	12/17/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152284	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	56	06111	39.74248474	-121.8493369	Butte County
62200	Fee-for-Service	1457731242	1457731242	1	1	JANDA, MAHAJAN & BALSIGER PL	9/30/2022	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
62229	Fee-for-Service	1871554022	1871554022	1	1	JANG, SUSIE C MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73572	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
62249	Fee-for-Service	1164645958	1164645958	1	1	JONES, MAISHA E NP	5/19/2017	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
62290	Fee-for-Service	1891278966	1891278966	1	1	JIMENEZ, KRISTINA L	10/16/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	378 41ST STREET	None	BANNING	CA	92220	3048	33	06065	33.9288385	-116.9221354	Riverside County
62315	Fee-for-Service	1750478707	1750478707	1	1	JAMES GERALD CARLISLE MD	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 MEDICAL DR	None	BOUNTIFUL	UT	84010	4908	00	None	40.88671331	-111.8683023	Davis County
62362	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	10/25/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
62374	Fee-for-Service	1033441316	1033441316	1	1	JONES, SETAREH MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110010	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 112	SAN DIEGO	CA	92123	4226	37	06073	32.798889	-117.150826	San Diego County
62406	Fee-for-Service	1417188061	1417188061	1	1	JAGODZINSKI, JASON E MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135948	20	Orthopedic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
62472	Fee-for-Service	1194897843	1194897843	1	1	JUAREZ, YVONNE MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78350	40	Pediatrics	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
62491	Fee-for-Service	1609125152	1609125152	1	1	JF URGENT CARE MEDICAL CLINI	6/25/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CS INC	5088 N FRESNO ST	A	FRESNO	CA	93710	7611	10	06019	36.810081	-119.781342	Fresno County
62500	Fee-for-Service	1104088996	1104088996	1	1	JACOB, JINCY MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116405	01	General Practice	0	In state provider	None	832 S GREVILLEA AVE	None	INGLEWOOD	CA	90301	3312	19	06037	33.9529004	-118.3548473	Los Angeles County
62504	Fee-for-Service	1306107560	1306107560	1	1	JOHNNY NGUON CHENG	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
62519	Fee-for-Service	1861073322	1861073322	2	1	JACOBSON, HOLLY L CNP	1/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	893 PATRIOT DR	STE A	MOORPARK	CA	93021	3357	56	06111	34.27852938	-118.8627331	Ventura County
62521	Fee-for-Service	1538247333	1538247333	1	1	JONES, TIM T MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	58066	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
62619	Fee-for-Service	1174850911	1174850911	1	1	JUAREZ, MARIANNE A MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116129	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
62633	Fee-for-Service	1053605212	1053605212	1	1	JONES, ERIC A LMFT	12/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	89584	-	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
62652	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	8/13/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
62736	Fee-for-Service	1942708185	1942708185	1	1	JOHNSON, CLAUDIA LPCC	10/22/2024	101YM0800X	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
62754	Fee-for-Service	1639199870	1639199870	1	1	JONES, KELLY L MD	8/3/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76087	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
62852	Fee-for-Service	1093708935	1093708935	1	1	JONATHAN D RUZI, 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	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	2369	00	None	33.486606	-112.071654	Maricopa County
62937	Fee-for-Service	1912008095	1912008095	1	1	JOHN BROWN	7/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
62938	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	1/25/2022	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
62970	Fee-for-Service	1659307908	1659307908	1	1	JAREMA, EDWARD J MD	12/4/1986	207P00000X	NA	Other	026	PHYSICIANS	40482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
62973	Fee-for-Service	1558586438	1558586438	1	2	JOHN P KELLY MD A PROFESSION	12/22/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AL MEDICAL CORPORATION	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.714	-117.9333585	Orange County
62991	Fee-for-Service	1326043399	1326043399	1	1	JACKSON, GARRELL K	1/14/2008	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4535 MISSOURI FLAT ROAD	SUITE 1E	PLACERVILLE	CA	95667	6808	09	06017	38.69980395	-120.8227032	El Dorado County
63002	Fee-for-Service	1982362869	1982362869	1	1	J AND C MEDICAL TRANSPORTATI	4/26/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON INC.	10701 CEDAR AVE	SPC 83	BLOOMINGTON	CA	92316	2335	36	06071	34.058592	-117.396343	San Bernardino County
63010	Fee-for-Service	1205939840	1205939840	1	1	JIMMY CHUA M.D.	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3810 PLAZA WAY	None	KENNEWICK	WA	99338	2722	00	None	46.17644625	-119.1911845	Benton County
63026	Fee-for-Service	1063527711	1063527711	1	1	JOHNSON, KENNETH B MD	10/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79802	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
63057	Fee-for-Service	1740357631	1740357631	1	1	JASSO, NANCY E MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67940	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
63082	Fee-for-Service	1659320463	1659320463	1	1	JAYARAM, VEENA DO	4/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	7585	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
63102	Fee-for-Service	1316218381	1316218381	1	1	JACOBSEN, SANNE B CRNA	2/21/2012	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
63125	Fee-for-Service	1760062608	1760062608	1	1	JAHAN, SONIA MD	7/3/2024	390200000X	NA	Other	026	PHYSICIANS	None	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
63135	Fee-for-Service	1841220167	1841220167	1	1	JACOB BLEESING MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
63163	Fee-for-Service	1467286781	1467286781	1	1	JOHNSON, CRYSTAL NP	3/24/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5888 EDINGER AVE	None	HUNTINGTON BEACH	CA	92649	1705	30	06059	33.72993249	-118.0255995	Orange County
63197	Fee-for-Service	1275876088	1275876088	1	1	JABLON, KIMBERLY H MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	9994	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
63216	Fee-for-Service	1912029190	1912029190	1	1	JAIN, BHAWNA MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68306	38	Geriatrics	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
63227	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	8/13/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
63269	Fee-for-Service	1447507751	1447507751	1	1	JOGIA, PRIYA J LCSW	6/15/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
63312	Fee-for-Service	1063527711	1063527711	1	1	JOHNSON, KENNETH B MD	10/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79802	68	Hematology	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
63335	Fee-for-Service	1033541644	1033541644	1	1	JOHNSON-WOLF, BRITTANY A LMF	10/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	155	RANCHO CUCAMONGA	CA	91730	7605	36	06071	34.10227306	-117.5715643	San Bernardino County
63355	Fee-for-Service	1982613600	1982613600	1	1	JACOBSON, BRENNA L MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78306	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
63369	Fee-for-Service	1578153573	1578153573	1	1	JETTON, KERYNN E CD	1/10/2024	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
63425	Fee-for-Service	1023689585	1023689585	1	1	JOHNSON, ASHLEY Z NP	7/18/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63428	Fee-for-Service	1740793090	1740793090	1	1	JUAN C CARRILLO MD A PROFESS	5/10/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2880 STORY RD	2ND FLOOR	SAN JOSE	CA	95127	3942	43	06085	37.3537019	-121.8227358	Santa Clara County
63503	Fee-for-Service	1912029190	1912029190	1	1	JAIN, BHAWNA MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68306	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
63516	Fee-for-Service	1326338237	1326338237	2	1	JAVEED SIDDIQUI, MD, MPH, PC	1/25/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
63521	Fee-for-Service	1760407621	1760407621	1	1	J & L DE LEON MEDICAL	4/18/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CORPORATION	16660 PARAMOUNT BLVD	STE 211	PARAMOUNT	CA	90723	5469	19	06037	33.882723	-118.1599535	Los Angeles County
63595	Fee-for-Service	1265439038	1265439038	1	1	JOHNSON, STEVEN G MD	1/14/1997	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	33624	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
63617	Fee-for-Service	1649244385	1649244385	1	1	JOHNSON, EDWARD G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	67344	01	General Practice	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
63641	Fee-for-Service	1568020196	1568020196	1	1	JESSICA BALLARD	1/13/2024	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 SAINT VINCENTS DR	None	BIRMINGHAM	AL	35205	1601	00	None	33.50797049	-86.7887482	Jefferson County
63688	Fee-for-Service	1013160480	1013160480	1	2	JOSHUA, ALFRED A MD	2/3/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	105792	-	NOT APPLICABLE	0	In state provider	None	2300 E 7TH ST	None	NATIONAL CITY	CA	91950	2852	37	06073	32.68320013	-117.0838567	San Diego County
63699	Fee-for-Service	1033640933	1033640933	1	1	JOHNSON, KENNETH R MD	1/29/2020	207P00000X	NA	Other	026	PHYSICIANS	159476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
63707	Fee-for-Service	1609372697	1609372697	1	1	JOHNSON, CORY MD MPH	9/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166923	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
63759	Fee-for-Service	1366444341	1366444341	1	1	JAYANTIBHAI PATEL, 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	1520 S DOBSON RD	SUITE 213A	MESA	AZ	85202	0000	00	None	33.387444	-111.876894	Maricopa County
63769	Fee-for-Service	1043476351	1043476351	1	1	JAZAYERI, POOYA MD	5/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111183	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
63807	Fee-for-Service	1760407621	1760407621	1	1	J & L DE LEON MEDICAL	4/18/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CORPORATION	16660 PARAMOUNT BLVD	STE 211	PARAMOUNT	CA	90723	5469	19	06037	33.882723	-118.1599535	Los Angeles County
63911	Fee-for-Service	1689864456	1689864456	1	1	JESSE SHRIKI, D.O.	7/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
63921	Fee-for-Service	1891981098	1891981098	1	1	JEON, EDWARD H MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24941	13	Neurology (M.D. only)	0	In state provider	None	23101 SHERMAN PL	STE 405	WEST HILLS	CA	91307	2033	19	06037	34.20099112	-118.6297991	Los Angeles County
63978	Fee-for-Service	1457813131	1457813131	1	1	JADE 2 PHARMACY INC	11/20/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10133 S DE ANZA BLVD	None	CUPERTINO	CA	95014	2126	43	06085	37.320597	-122.032428	Santa Clara County
64100	Fee-for-Service	1154436202	1154436202	1	1	JOHNSON, KAREN S MD	7/12/1990	207P00000X	NA	Other	026	PHYSICIANS	69140	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
64120	Fee-for-Service	1528543394	1528543394	1	1	JOHN A GOROSTIZA VILLANUEVA	2/24/2025	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MD, INC	2121 W MAGNOLIA BLVD	STE B	BURBANK	CA	91506	1706	19	06037	34.17309265	-118.3314784	Los Angeles County
64189	Fee-for-Service	1881124717	1881124717	1	1	JOHNS, BRITTANY LMFT	3/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	116566	-	NOT APPLICABLE	0	In state provider	None	3115 REDHILL AVENUE	None	COSTA MESA	CA	92626	4517	30	06059	33.6763772	-117.8776418	Orange County
64238	Fee-for-Service	1346366598	1346366598	1	1	JOLIN, DONALD R CRNA	6/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
64271	Fee-for-Service	1265790745	1265790745	2	1	JIROUTEK, VANESSA L LMFT	11/11/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25101 THE OLD ROAD	SUITE 216	NEWHALL	CA	91381	2206	19	06037	34.3740128	-118.5631527	Los Angeles County
64283	Fee-for-Service	1679533186	1679533186	1	1	JACOBS, MARK MD	6/10/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45317	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
64310	Fee-for-Service	1417122391	1417122391	1	1	JOHNSON, BRIAN D MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105124	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
64315	Fee-for-Service	1376564781	1376564781	1	1	JOHANSON, MARCIA L PT	5/4/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	588 NORTH SUNRISE AVENUE	SUITE 100	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
64366	Fee-for-Service	1275559692	1275559692	1	1	JACOBSEN, REBECCA H PHD	5/22/1998	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
64373	Fee-for-Service	1265070064	1265070064	1	1	JANETS ENTERPRISE INC	5/21/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3395 BROADMOOR BLVD	None	SAN BERNARDINO	CA	92404	2403	36	06071	34.152759	-117.2778705	San Bernardino County
64518	Fee-for-Service	1588291892	1588291892	1	1	JIN, RICHARD M MD	8/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179526	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
64627	Fee-for-Service	1700893492	1700893492	1	1	JINDAL, RAKESH MD	9/9/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	32366	41	Internal Medicine	0	In state provider	None	263 PEARSON DR	STE 206	PORTERVILLE	CA	93257	3333	54	06107	36.07050297	-119.0277645	Tulare County
64756	Fee-for-Service	1396011680	1396011680	1	1	JOSEPH L WHETSTONE MD	5/23/2017	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
64765	Fee-for-Service	1962487421	1962487421	1	1	JAVAHERI, SHAHIN M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67343	04	Otology, Laryngology, Rhinology	0	In state provider	UCI HEAD AND NECK SURGER	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
64775	Fee-for-Service	1730821646	1730821646	1	1	JUTHANI, PRERAK V MD	3/28/2025	207R00000X	NA	Other	026	PHYSICIANS	190006	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
64867	Fee-for-Service	1801358775	1801358775	1	1	JANG, TIMOTHY MD	4/3/2025	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
64904	Fee-for-Service	1053387894	1053387894	1	1	JANSELEWITZ, 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	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
64931	Fee-for-Service	1881653566	1881653566	1	1	JAMI, MOHAMMAD M MD	2/1/2001	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	50493	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
65096	Fee-for-Service	1497704738	1497704738	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC.	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
65118	Fee-for-Service	1841416559	1841416559	1	1	JOINER, THOMAS D LCSW	3/27/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1111 WEST TOKAY STREET	SUITE A	LODI	CA	95240	3965	39	06077	38.1263635	-121.286538	San Joaquin County
65171	Fee-for-Service	1306821038	1306821038	1	1	JENNIFER RAUM	6/23/2016	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
65205	Fee-for-Service	1871694653	1871694653	1	1	JOHN NAH KWAK, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3535 OLENTANGY RIVER RD	None	COLUMBUS	OH	43214	3908	00	None	40.03000546	-83.0337399	Franklin County
65224	Fee-for-Service	1811059660	1811059660	1	1	JAMES K SPEED 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	750 ALLIANCE COURT	None	ASHEVILLE	NC	28806	2248	00	None	35.521902	-82.5992865	Buncombe County
65285	Fee-for-Service	1265879076	1265879076	1	1	JIMENEZ, ALEJANDRO C MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133308	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
65360	Fee-for-Service	1750951695	1750951695	1	1	JDB SPEECH LANGUAGE SERVICES	10/25/2022	261QH0700X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE	314	TUSTIN	CA	92780	7234	30	06059	33.70954889	-117.8043627	Orange County
65379	Fee-for-Service	1952344475	1952344475	1	1	JOHNSTON, KATHRYN MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42206	07	Dermatology	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
65411	Fee-for-Service	1942211651	1942211651	1	1	JOY, GREGORY J MD	8/24/2004	207P00000X	NA	Other	026	PHYSICIANS	25323	41	Internal Medicine	0	In state provider	None	26922 OSO PKWY	STE 380	MISSION VIEJO	CA	92691	5800	30	06059	33.58335125	-117.6606039	Orange County
65507	Fee-for-Service	1407876063	1407876063	1	1	JOHNSON, DEREK O DO	12/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8220	08	Family Practice	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
65613	Fee-for-Service	1952342131	1952342131	1	1	JAMES M SCHMIDT	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
65628	Fee-for-Service	1770631509	1770631509	1	1	JOAQUIN, AGNES R MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51522	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
65821	Fee-for-Service	1861885444	1861885444	1	1	JOHNSON, AARON A DO	10/1/2021	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
65891	Fee-for-Service	1205084837	1205084837	1	1	JOHNSON, ALICIA CRNA	10/10/2023	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
65893	Fee-for-Service	1932110731	1932110731	1	1	JOHN MYERS, MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
65895	Fee-for-Service	1386286193	1386286193	1	1	JONATHAN CHAN O.D. INC	4/9/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2615 TUSCANNY ST	None	CORONA	CA	92881	4631	33	06065	33.826887	-117.516447	Riverside County
65898	Fee-for-Service	1790700904	1790700904	1	1	JOHNS HOPKINS BAYVIEW MEDICA	10/17/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4940 EASTERN AVE	None	BALTIMORE	MD	21224	2735	00	None	39.28743553	-76.54964947	City of Baltimore
65929	Fee-for-Service	1720285620	1720285620	1	1	JOHNSON, CHRISTOPHER D MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115329	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
66018	Fee-for-Service	1578536587	1578536587	1	1	JENKINS, RONALD WM	2/14/2009	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1534 TENNESSEE ST	None	VALLEJO	CA	94590	4627	48	06095	38.1098075	-122.2396425	Solano County
66061	Fee-for-Service	1790759330	1790759330	1	1	JUDITH,JOYCE 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	3705 FIFTH AVE	RM 3950	PITTSBURGH	PA	15213	0000	00	None	40.44154544	-79.95885126	Allegheny County
66142	Fee-for-Service	1467983957	1467983957	1	1	JUNG, BRIAN C MD	6/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	158919	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
66150	Fee-for-Service	1396908869	1396908869	1	1	JIMENEZ, GLORIA A DO	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10668	02	General Surgery	0	In state provider	None	1668 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1522	44	06087	36.99025828	-121.9810944	Santa Cruz County
66299	Fee-for-Service	1265728448	1265728448	1	1	JAVA PSYCHIATRY INC	11/21/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	105749	36	Psychiatry	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
66334	Fee-for-Service	1417973603	1417973603	1	1	JORDAN M LAUB MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	24800 SE STARK	None	GRESHAM	OR	97030	3378	00	None	45.516762	-122.4070245	Multnomah County
66370	Fee-for-Service	1962459453	1962459453	1	1	JAO, BIENVENIDO O MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93725	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
66404	Fee-for-Service	1417390345	1417390345	1	1	JONES, ERIN A MD	9/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142366	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
66472	Fee-for-Service	1912001157	1912001157	1	1	JOHNSON, JENNIFER MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88979	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
66502	Fee-for-Service	1609033182	1609033182	1	1	JACKSON, GAVIN N MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110647	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
66531	Fee-for-Service	1780687277	1780687277	2	1	JCH PHARMACY HOLDINGS INC	7/22/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3257 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5220	34	06067	38.567835	-121.4643735	Sacramento County
66591	Fee-for-Service	1417160771	1417160771	1	1	JOHNSTON, MICHAEL D MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125993	41	Internal Medicine	0	In state provider	None	2721 OLIVE HWY	STE 12B	OROVILLE	CA	95966	6118	04	06007	39.50452062	-121.5420592	Butte County
66729	Fee-for-Service	1043863160	1043863160	1	1	JENMI, ZAINOB NP	9/24/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
66789	Fee-for-Service	1609033182	1609033182	1	1	JACKSON, GAVIN N MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110647	67	Endocrinology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
66859	Fee-for-Service	1467865824	1467865824	1	1	JUN, EMILY MD	4/26/2019	390200000X	NA	Other	026	PHYSICIANS	160039	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
66890	Fee-for-Service	1265605307	1265605307	1	1	JASON BROWN MD INC AMC	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74409	05	Anesthesiology	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92672	2827	30	06059	33.45756029	-117.6497373	Orange County
66973	Fee-for-Service	1588767016	1588767016	1	1	JAKUS, SHARON M MD	9/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96214	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
67023	Fee-for-Service	1528336765	1528336765	1	2	JENNY HUNG OD INC	5/11/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3943 GRAND AVE	None	CHINO	CA	91710	5440	36	06071	33.995241	-117.7193205	San Bernardino County
67081	Fee-for-Service	1912939471	1912939471	2	1	JENNIFER TUFARIELLO	6/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	590 COUNTRY CLUB PKWY	None	EUGENE	OR	97401	6025	00	None	44.06393879	-123.0919866	Lane County
67149	Fee-for-Service	1568539450	1568539450	1	1	JEHAN, FAISAL S MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83659	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
67198	Fee-for-Service	1528009008	1528009008	1	1	JAMEHDOR, ALI DO	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9114	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
67220	Fee-for-Service	1952592768	1952592768	1	1	JULAZADEH, SARA OD	2/26/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	318 E COMPTON BLVD	None	COMPTON	CA	90221	3206	19	06037	33.89597324	-118.2191747	Los Angeles County
67266	Fee-for-Service	1144625997	1144625997	1	1	JADAUN, PUSHKAL MD	6/17/2022	207R00000X	NA	Other	026	PHYSICIANS	150326	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
67390	Fee-for-Service	1649954983	1649954983	1	1	JOHNSON, CARRIE A LMFT	7/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
67396	Fee-for-Service	1871898064	1871898064	1	1	JUDEH, JIHAN V LMFT	11/7/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51292	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	SUITE 316	NORWALK	CA	90650	9319	19	06037	33.90523023	-118.0681168	Los Angeles County
67466	Fee-for-Service	1063545606	1063545606	1	1	JUN, PETER MD	2/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97010	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
67527	Fee-for-Service	1609827039	1609827039	1	1	JAMALUDDIN, UMAIMA S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29392	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A PROFESSIONAL CORP	3941 SAN DIMAS ST	BLDG 1	BAKERSFIELD	CA	93301	5734	15	06029	35.39552345	-119.0082184	Kern County
67602	Fee-for-Service	1245389782	1245389782	1	1	JOHNSON, JESSICA K	3/19/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
67608	Fee-for-Service	1336474568	1336474568	1	2	JEAN-MURAT, CAROLLE MD FACO	11/1/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	39012	None	None	0	In state provider	G	4276 54TH	C	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
67632	Fee-for-Service	1548682081	1548682081	1	1	JEPSON, COURTNEY B LCSW	4/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 E REDLANDS BLVD	246	REDLANDS	CA	92373	4725	36	06071	34.05731952	-117.181197	San Bernardino County
67658	Fee-for-Service	1831395482	1831395482	1	1	JENSEN, SHELDON DO	9/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18797	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
67684	Fee-for-Service	1275152449	1275152449	1	1	JIN, ALEXANDER H MD	7/15/2023	208M00000X	NA	Other	026	PHYSICIANS	187550	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
67720	Fee-for-Service	1174555775	1174555775	1	1	JURMAIN, RICHARD B MD	1/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	22905	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11645 WILSHIRE BLVD	STE 825	LOS ANGELES	CA	90025	6809	19	06037	34.05005135	-118.4602303	Los Angeles County
67774	Fee-for-Service	1821558495	1821558495	1	1	JOAQUIN, CHRISTIAN DO	2/21/2025	208M00000X	NA	Other	026	PHYSICIANS	22817	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
67801	Fee-for-Service	1477581866	1477581866	1	1	JOHNSTON, SEAN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73716	30	Radiology	0	In state provider	None	8641 WILSHIRE BLVD	STE 105	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
67828	Fee-for-Service	1346029980	1346029980	1	1	JOSHUA KING MD INC	11/20/2023	193400000X	NA	Other	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	35470 WHITEWOOD ROAD	None	MURRIETA	CA	92563	2415	33	06065	33.60671588	-117.1628131	Riverside County
67847	Fee-for-Service	1306281837	1306281837	1	1	JOSHI, KUNAL N	1/21/2025	208M00000X	NA	Other	026	PHYSICIANS	169261	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
67849	Fee-for-Service	1184637308	1184637308	1	1	JONES, SOPHIA S MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88425	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
68004	Fee-for-Service	1497946883	1497946883	1	1	JONES, BLANDING U MD	12/26/2007	208G00000X	NA	General Surgery	026	PHYSICIANS	68821	33	Thoracic 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
68042	Fee-for-Service	1275753493	1275753493	1	1	JOHN MUIR MEDICAL CENTER	2/4/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK CAMPUS	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
68046	Fee-for-Service	1831805035	1831805035	1	1	JELEN OPTOMETRY INC.	10/30/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	620 W YOSEMITE AVE	None	MADERA	CA	93637	4523	20	06039	36.95712331	-120.0665526	Madera County
68076	Fee-for-Service	1992944896	1992944896	1	1	JONES, VAUGHN CRNA	5/1/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
68083	Fee-for-Service	1548647589	1548647589	1	1	JONATHAN DAVID COKER	4/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
68144	Fee-for-Service	1215135462	1215135462	1	1	JOHL, HARPREET K MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109463	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
68225	Fee-for-Service	1770110587	1770110587	1	1	JAGADEESAN, PRIYA	4/17/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
68255	Fee-for-Service	1699173922	1699173922	1	2	JAH HAND SURGERY	5/7/2024	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	S	3617 AVALON BLVD STE 200	None	LOS ANGELES	CA	90011	5601	19	06037	34.012953	-118.2652865	Los Angeles County
68294	Fee-for-Service	1033215488	1033215488	1	1	JOHNSON, LARISA M OD	11/4/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1689 ARDEN FAIR MALL	SUITE 1091	SACRAMENTO	CA	95815	4096	34	06067	0	0	None
68302	Fee-for-Service	1700510518	1700510518	1	1	JML FAMILY HEALTHCARE INC	12/29/2022	207RG0300X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15366 ELEVENTH ST	STE C	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
68327	Fee-for-Service	1275753493	1275753493	1	1	JOHN MUIR MEDICAL CENTER	2/4/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK CAMPUS	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
68329	Fee-for-Service	1477754042	1477754042	1	1	JONG, KIMMY M MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100001	40	Pediatrics	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4396	52	06103	40.14921426	-122.2216794	Tehama County
68347	Fee-for-Service	1205072154	1205072154	1	2	J W DUNCAN MD AMC	2/19/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2200 W THIRD STREET	SUITE 100	LOS ANGELES	CA	90057	1934	19	06037	34.06329642	-118.2739484	Los Angeles County
68446	Fee-for-Service	1689680324	1689680324	1	1	JENKUSKY, STEVEN 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	2211 LOMAS BLVD NE	None	ALBEQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
68507	Fee-for-Service	1720060791	1720060791	1	1	JORDAN, JOHN E MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60013	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
68516	Fee-for-Service	1699249359	1699249359	1	1	JIMENEZ, TINA R PSYD	3/5/2025	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68590	Fee-for-Service	1700510518	1700510518	1	1	JML FAMILY HEALTHCARE INC	12/29/2022	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15366 ELEVENTH ST	STE C	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
68719	Fee-for-Service	1790785434	1790785434	1	1	JUTABHA, ROME MD PC	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	68613	10	Gastroenterology (M.D. only)	0	In state provider	SERVICES INC	100 UCLA MEDICAL PLAZA	STE 310	LOS ANGELES	CA	90095	7031	19	06037	34.0651473	-118.4458393	Los Angeles County
68765	Fee-for-Service	1992861058	1992861058	1	1	JOHNTIN MEDICAL GRP INC	5/23/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1722 DESIRE AVE	STE 208	ROWLAND HEIGHTS	CA	91748	2970	19	06037	33.98725948	-117.8963129	Los Angeles County
68780	Fee-for-Service	1568492643	1568492643	1	1	JANZEN, CARLA MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71802	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA SUITE 502	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
68952	Fee-for-Service	1225738867	1225738867	1	1	JING, ZHI CRNA	8/7/2023	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
68977	Fee-for-Service	1346816840	1346816840	1	1	JUANG, ISABEL W PT	6/20/2022	2251X0800X	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
69015	Fee-for-Service	1922156850	1922156850	1	1	JOHNSON-SIMS, MESHANETTE LM	11/29/2024	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
69040	Fee-for-Service	1821600537	1821600537	1	1	JAMES LESHER MD	12/18/2020	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	20103 LAKE CHABOT RD.	None	CASTRO VALLEY	CA	94546	4062	01	06001	37.698264	-122.090112	Alameda County
69043	Fee-for-Service	1457305641	1457305641	1	1	JOHANSSON, KARL H MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	23456	01	General Practice	0	In state provider	None	2809 OLIVE HWY	STE 220	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
69053	Fee-for-Service	1992861058	1992861058	1	1	JOHNTIN MEDICAL GRP INC	5/23/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1722 DESIRE AVE	STE 208	ROWLAND HEIGHTS	CA	91748	2970	19	06037	33.98725948	-117.8963129	Los Angeles County
69064	Fee-for-Service	1114210176	1114210176	1	1	JIANG, YI MD	6/18/2019	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	159100	18	Ophthalmology	0	In state provider	None	416 W LAS TUNAS DR	STE 105	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
69242	Fee-for-Service	1659460814	1659460814	1	1	JACKSON, GRACE E MD	5/13/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	56001	36	Psychiatry	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
69317	Fee-for-Service	1871662270	1871662270	1	1	JONES, LASONYA D MD	9/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138473	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
69332	Fee-for-Service	1457305641	1457305641	1	1	JOHANSSON, KARL H MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	23456	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2809 OLIVE HWY	STE 220	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
69357	Fee-for-Service	1285638619	1285638619	1	1	JANAI, HILLEL K MD	4/24/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48584	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
69440	Fee-for-Service	1811359706	1811359706	1	1	JAIRAM, VIKRAM MD	8/10/2023	2085R0001X	NA	Other	026	PHYSICIANS	187674	None	None	0	In state provider	None	3320 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94190958	-121.1061362	Placer County
69448	Fee-for-Service	1609105204	1609105204	1	1	JARVINA JONATHAN	9/24/2017	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
69449	Fee-for-Service	1164980744	1164980744	1	1	J&P SPINE CENTER INC.	2/9/2022	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	6079 N FRESNO ST	SUITE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
69451	Fee-for-Service	1609171719	1609171719	1	1	JINA, ALKARIM S MD	1/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50153	01	General Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
69535	Fee-for-Service	1295014025	1295014025	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
69555	Fee-for-Service	1699228619	1699228619	1	1	JACK, MARK CPO	8/26/2016	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3160 GENEVA ST	None	LOS ANGELES	CA	90020	1117	19	06037	34.06768353	-118.286397	Los Angeles County
69563	Fee-for-Service	1386708634	1386708634	1	1	JWCH INSTITUTE, INC	6/29/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	JWCH NORWALK REGIONAL	12360 FIRESTONE BLVD	None	NORWALK	CA	90650	4324	19	06037	33.90615795	-118.0698073	Los Angeles County
69575	Fee-for-Service	1215295449	1215295449	1	1	JACOB, THOMAS MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131098	40	Pediatrics	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
69823	Fee-for-Service	1295014025	1295014025	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
69825	Fee-for-Service	1932141124	1932141124	1	1	JUDGE, ANDLEEB K MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80979	41	Internal Medicine	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
69852	Fee-for-Service	1386708634	1386708634	1	1	JWCH INSTITUTE, INC	6/29/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	JWCH NORWALK REGIONAL	12360 FIRESTONE BLVD	None	NORWALK	CA	90650	4324	19	06037	33.90615795	-118.0698073	Los Angeles County
69932	Fee-for-Service	1649203415	1649203415	1	1	JAMIESON, STUART W MD	1/1/1982	208G00000X	NA	General Surgery	026	PHYSICIANS	35080	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
70000	Fee-for-Service	1568083376	1568083376	1	1	JILANI, TALHA MD	12/18/2023	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
70041	Fee-for-Service	1962766584	1962766584	1	1	JUANG, JEREMY MD	9/2/2022	207L00000X	NA	Other	026	PHYSICIANS	170703	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
70108	Fee-for-Service	1417919440	1417919440	1	1	JOAN GOODMAN	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
70110	Fee-for-Service	1295014025	1295014025	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
70140	Fee-for-Service	1528021649	1528021649	1	1	JEREMY WARFORD	2/28/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1800 BYPASS RD	None	HEBER SPRING	AR	72543	0000	00	None	35.504415	-91.9981125	Cleburne County
70142	Fee-for-Service	1386708634	1386708634	1	1	JWCH INSTITUTE, INC	6/29/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	JWCH NORWALK REGIONAL	12360 FIRESTONE BLVD	None	NORWALK	CA	90650	4324	19	06037	33.90615795	-118.0698073	Los Angeles County
70157	Fee-for-Service	1538622014	1538622014	1	1	JACQUES, KAYLA M	6/3/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	185544	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
70218	Fee-for-Service	1184087801	1184087801	1	1	JORDAN, CHRISTIAN	9/25/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	171637	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
70265	Fee-for-Service	1447503826	1447503826	1	1	JACK, GREGORY S MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83253	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	7001	19	06037	34.06373445	-118.443537	Los Angeles County
70314	Fee-for-Service	1952964744	1952964744	1	1	JEROMY ASIDO NP PSYCHIATRIC	4/18/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NURSING SERVICES INC	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
70381	Fee-for-Service	1154512036	1154512036	1	1	JOHNSON, JEVON J MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101110	36	Psychiatry	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
70420	Fee-for-Service	1154399459	1154399459	1	1	JAMES LEE BURKE	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE & C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.778496	-111.8805615	Salt Lake County
70526	Fee-for-Service	1699334847	1699334847	1	1	JARMAN, KEV'ANN D NP	3/20/2024	363A00000X	NA	Physician Assistant	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
70593	Fee-for-Service	1073595740	1073595740	1	1	JIMENEZ, SANTIAGO MD	5/18/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	114542	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
70632	Fee-for-Service	1194251595	1194251595	1	1	JESMOND RIDGE MEDICAL	5/1/2017	207VF0040X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERVICES A MEDICAL	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
70684	Fee-for-Service	1891057923	1891057923	1	1	JAMES ABRAM MCBRIDE	2/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1644 MEDICAL CENTER PT	STE 200	COLORADO SPGS	CO	80907	5765	00	None	38.87478821	-104.7970184	El Paso County
70767	Fee-for-Service	1538166384	1538166384	1	1	J.G.S. PHARMACIES INC	6/27/2002	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 W COLLEGE AVE	None	SANTA ROSA	CA	95401	5059	49	06097	38.44566	-122.7408705	Sonoma County
70802	Fee-for-Service	1104123165	1104123165	1	1	JOGU, PRASAD MD	3/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153206	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
70808	Fee-for-Service	1326168048	1326168048	1	1	JEFFERSON ELEM SD	4/30/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	101 LINCOLN AVE	None	DALY CITY	CA	94015	3934	41	06081	37.67900253	-122.48496	San Mateo County
70913	Fee-for-Service	1144430422	1144430422	1	1	JAVERI, KHALID K MD	11/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112857	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
70982	Fee-for-Service	1740680867	1740680867	1	1	JEMJEM, LOZA H MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136307	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
71092	Fee-for-Service	1699970129	1699970129	1	1	JUE, ANDREA T MD	3/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119849	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	#540	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
71119	Fee-for-Service	1235101346	1235101346	1	1	JACKSON, MINAL D MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111952	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
71160	Fee-for-Service	1295926939	1295926939	1	1	JOHN HAWLEY OPTOMETRIC CORP	6/15/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3911 COFFEE RD	STE B	BAKERSFIELD	CA	93308	5024	15	06029	35.395299	-119.092337	Kern County
71374	Fee-for-Service	1871511840	1871511840	1	1	JUE, TERRY L MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84939	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
71440	Fee-for-Service	1316092802	1316092802	1	1	JOKVAR, SAYED MD INC	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55392	18	Ophthalmology	0	In state provider	None	15251 NATIONAL AVE	STE 100	LOS GATOS	CA	95032	2400	43	06085	37.24637433	-121.9500289	Santa Clara County
71546	Fee-for-Service	1326177874	1326177874	1	2	JOHN H CHOIE MD PC	7/16/2024	174400000X	NA	Other	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5385 WALNUT AVE	STE. 6	CHINO	CA	91710	2605	36	06071	34.02627451	-117.6872175	San Bernardino County
71600	Fee-for-Service	1902952807	1902952807	1	1	JENNINGS, PATRICIA L LMFT	9/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 WILSHIRE BLVD	SUITE 204	SANTA MONICA	CA	90401	1737	19	06037	34.02196363	-118.4947537	Los Angeles County
71648	Fee-for-Service	1881322592	1881322592	1	1	JALSINGH, ANANYA OD	8/28/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	687 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5628	37	06073	32.7086752	-117.0114942	San Diego County
71749	Fee-for-Service	1134480510	1134480510	1	1	JIANG, KEVIN MD	11/9/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	153109	25	Physical Medicine and Rehabilitation	0	In state provider	None	12840 RIVERSIDE DR	SUITE 208	VALLEY VILLAGE	CA	91607	3327	19	06037	34.15759054	-118.4129775	Los Angeles County
71821	Fee-for-Service	1841023801	1841023801	1	1	JAVIER R. RIOS MD A PROFESSI	8/27/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IAR	4022 CHICAGO AVE	None	RIVERSIDE	CA	92507	5340	33	06065	33.97369354	-117.3484788	Riverside County
71894	Fee-for-Service	1003235235	1003235235	1	1	JAQUA, ECLER E MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143997	01	General Practice	0	In state provider	None	25455 BARTON RD	SUITE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
71969	Fee-for-Service	1851064133	1851064133	1	1	JACKSON, DANIELLE L LCSW	8/2/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
71977	Fee-for-Service	1164593372	1164593372	1	1	JONES III, WALTER MD INC	2/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54962	41	Internal Medicine	0	In state provider	None	255 TERRACINA BLVD	STE 101	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
72060	Fee-for-Service	1992067045	1992067045	1	1	JALABA, LINDA C PT	6/20/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
72171	Fee-for-Service	1760835300	1760835300	1	1	JACKSON, SUSAN H LMFT	6/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
72182	Fee-for-Service	1003235235	1003235235	1	1	JAQUA, ECLER E MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143997	38	Geriatrics	0	In state provider	None	25455 BARTON RD	SUITE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
72241	Fee-for-Service	1295962025	1295962025	1	1	JONES, PAMELA S MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143630	14	Neurological Surgery	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
72335	Fee-for-Service	1154881522	1154881522	1	1	JAHANGIRI, PEGAH MD	11/5/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	187585	83	Rheumatology	0	In state provider	None	1335 BUENAVENTURA BLVD	100	REDDING	CA	96001	0000	45	06089	40.58222519	-122.4261823	Shasta County
72353	Fee-for-Service	1790890465	1790890465	1	1	JACOBSEN, BRENT E DO	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8142	66	Emergency Medicine (Urgent Care)	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
72371	Fee-for-Service	1992850531	1992850531	1	1	JOHNSON, JEFFREY L MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63743	40	Pediatrics	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
72492	Fee-for-Service	1952338543	1952338543	2	1	JACKSON, MONIQUE R	6/14/2005	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	SUITE B	LYNWOOD	CA	90262	3513	19	06037	33.92872742	-118.2006921	Los Angeles County
72597	Fee-for-Service	1245060722	1245060722	1	1	JULIN, LAI KUAN VERONICA NP	2/20/2025	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
72654	Fee-for-Service	1992850531	1992850531	1	1	JOHNSON, JEFFREY L MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63743	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
72699	Fee-for-Service	1477562072	1477562072	1	1	JOSEPH M BOBOVSKY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2811 TIETON DR	None	YAKIMA	WA	98902	3761	00	None	46.59274567	-120.54785	Yakima County
72855	Fee-for-Service	1598449746	1598449746	1	1	JAVIER, RICHARD ANGELO K CNP	7/21/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
72916	Fee-for-Service	1245668532	1245668532	1	1	JAKOUBEK, DANA L NP	9/26/2016	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
73011	Fee-for-Service	1366447633	1366447633	1	1	JULIEN, ALAN R OD	2/1/2000	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 COLORADO AVE	None	TURLOCK	CA	95382	2002	50	06099	37.51154259	-120.8352538	Stanislaus County
73168	Fee-for-Service	1437143443	1437143443	1	1	JOSHUA FRAME	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	292 S 1470 E	STE 100	ST GEORGE	UT	84790	1764	00	None	37.10310593	-113.5517436	Washington County
73192	Fee-for-Service	1225371081	1225371081	1	1	JOCSON, ANGELINE M MD	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136021	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
73229	Fee-for-Service	1033351689	1033351689	1	1	JUNG, JESSE J MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135262	18	Ophthalmology	0	In state provider	None	3300 TELEGRAPH AVENUE	None	OAKLAND	CA	94609	3028	01	06001	37.82176506	-122.266417	Alameda County
73341	Fee-for-Service	1366091233	1366091233	1	1	JESS RANCH HEALTHCARE LLC	10/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11959 APPLE VALLEY ROAD	None	APPLE VALLEY	CA	92308	7507	36	06071	34.46817454	-117.2423226	San Bernardino County
73396	Fee-for-Service	1811259203	1811259203	1	1	JANAKIRAMAN, NEHA V MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141994	01	General Practice	0	In state provider	None	1020 29TH STREET	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
73402	Fee-for-Service	1497994230	1497994230	1	1	JEREMY LEE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16901 LAKESIDE HILLS CT	None	OMAHA	NE	68130	2318	00	None	41.23701829	-96.18157861	Douglas County
73476	Fee-for-Service	1427554807	1427554807	1	1	JONES, APRIL LMFT	1/17/2025	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
73496	Fee-for-Service	1992185235	1992185235	1	1	JIANG, HANSI MD	10/3/2018	208M00000X	NA	Other	026	PHYSICIANS	147132	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
73589	Fee-for-Service	1528004850	1528004850	1	1	JUEL, RANDOLPH 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	2000 HOSPITAL DR	None	SEDRO WOOLLEY	WA	98284	4327	00	None	48.49548051	-122.2760925	Skagit County
73622	Fee-for-Service	1982047296	1982047296	1	1	JUAN, JAMIL PT	10/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
73648	Fee-for-Service	1508027442	1508027442	1	1	JOSEF, FADI MD	10/1/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	142390	36	Psychiatry	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
73695	Fee-for-Service	1962623447	1962623447	1	1	JACOBSON, BRENT R DO	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13762	30	Radiology	0	In state provider	None	2655 CAMINO DEL RIO N	STE 330	SAN DIEGO	CA	92108	1633	37	06073	32.77261373	-117.1347389	San Diego County
73936	Fee-for-Service	1508027442	1508027442	1	1	JOSEF, FADI MD	10/1/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	142390	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
73967	Fee-for-Service	1750464442	1750464442	1	1	JAMIE W MANER	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
74011	Fee-for-Service	1497270193	1497270193	1	1	JETTER, PAMELA R OD	11/20/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 4TH ST	None	LIVERMORE	CA	94550	4454	01	06001	37.67808567	-121.7724653	Alameda County
74123	Fee-for-Service	1659799955	1659799955	1	1	JALLER, DANIEL J MD	9/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
74127	Fee-for-Service	1073970323	1073970323	1	1	JENNIFER DUGAL	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	808 S WOOD MC722	None	CHICAGO	IL	60612	7323	00	None	41.8714195	-87.67152062	Cook County
74134	Fee-for-Service	1568092088	1568092088	1	1	JACKSON, GREGORY C PSYD	4/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
74151	Fee-for-Service	1194862771	1194862771	1	2	JESTER, ROBERT W.	11/17/2009	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	595 E 6TH ST	None	BEAUMONT	CA	92223	2217	33	06065	33.92934852	-116.9746245	Riverside County
74246	Fee-for-Service	1528135415	1528135415	1	1	JONG, PETER CHUN-MING MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55945	05	Anesthesiology	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
74274	Fee-for-Service	1356673271	1356673271	1	1	JOSHUA N HONEYMAN	9/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2 DUDLEY ST	STE 190	PROVIDENCE	RI	02905	3248	00	None	41.81068615	-71.40798057	Providence County
74304	Fee-for-Service	1356906739	1356906739	1	1	JOSHUA WOLFSOHN DO INC	9/18/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	4000 CALLE TECATE	SUITE 220	CAMARILLO	CA	93012	5289	56	06111	34.22147843	-119.0178246	Ventura County
74306	Fee-for-Service	1073033072	1073033072	1	1	JUNIPER MANOR, LLC	2/15/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	35223 JUNIPER AVENUE	None	YUCAIPA	CA	92399	2929	36	06071	34.07188388	-117.0356124	San Bernardino County
74362	Fee-for-Service	1265951016	1265951016	1	1	JUN, JESSICA NP	8/12/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	933 S SUNSET AVE	105	WEST COVINA	CA	91790	3410	19	06037	34.06428275	-117.9432037	Los Angeles County
74381	Fee-for-Service	1285911263	1285911263	1	1	JOARDER INC	2/8/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	324 S ALVARADO STREET	None	LOS ANGELES	CA	90057	2915	19	06037	34.06224493	-118.2731261	Los Angeles County
74453	Fee-for-Service	1518077437	1518077437	1	1	JAMES H GALLAFENT, 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
74511	Fee-for-Service	1568611861	1568611861	1	1	JENNINGS, TERRI E PHD	3/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12755 WEST END ROAD	None	ARCATA	CA	95521	8956	12	06023	40.876308	-124.0156755	Humboldt County
74669	Fee-for-Service	1174883995	1174883995	1	1	JOHNSON ROLFES, JULIE K MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127327	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
74692	Fee-for-Service	1831322312	1831322312	1	1	JESSIE PEARL HILL	2/2/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27892 JOHN F KENNEDY DR	UNIT C	MORENO VALLEY	CA	92555	5866	33	06065	33.9046497	-117.1755554	Riverside County
74749	Fee-for-Service	1578758116	1578758116	1	1	JENNINGS, MEAGAN M DPM	4/1/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
74763	Fee-for-Service	1669575106	1669575106	1	1	JAVDAN, FRED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76858	41	Internal Medicine	0	In state provider	None	11540 SANTA MONICA BLVD	STE 203	LOS ANGELES	CA	90025	7905	19	06037	34.04524404	-118.452534	Los Angeles County
74779	Fee-for-Service	1598840209	1598840209	1	1	JANIAN, NORICK J MD	7/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	40934	13	Neurology (M.D. only)	0	In state provider	None	95 MONTGOMERY DR	STE 102	SANTA ROSA	CA	95404	6617	49	06097	38.442357	-122.704641	Sonoma County
74829	Fee-for-Service	1699846642	1699846642	1	1	JAMES, ADELENE R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38435	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
74848	Fee-for-Service	1790264083	1790264083	1	1	JAFFA, WENDY N LCSW	2/8/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD STE 1	None	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
74872	Fee-for-Service	1104910306	1104910306	1	1	JOHNSON, DAVID MD	3/25/2013	208600000X	NA	General Surgery	026	PHYSICIANS	88275	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	E421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
74915	Fee-for-Service	1033296629	1033296629	1	2	JULKA, DILPREET P MD	10/5/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	55266	-	NOT APPLICABLE	0	In state provider	None	474 S CITRUS AVENUE	None	AZUSA	CA	91702	4734	19	06037	34.1148093	-117.8901388	Los Angeles County
74935	Fee-for-Service	1659863769	1659863769	1	1	JOSY SIMON, ALPHI	3/4/2019	363LP0808X	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
74978	Fee-for-Service	1831322312	1831322312	1	1	JESSIE PEARL HILL	2/2/2011	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27892 JOHN F KENNEDY DR	UNIT C	MORENO VALLEY	CA	92555	5866	33	06065	33.9046497	-117.1755554	Riverside County
75132	Fee-for-Service	1851004683	1851004683	1	1	JEH CORP	3/16/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6771 BEACH BLVD	STE E	BUENA PARK	CA	90621	3470	30	06059	33.8617412	-117.9982177	Orange County
75161	Fee-for-Service	1912180548	1912180548	1	1	JACOBSON, PAUL F LMFT	6/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	32 E SAN FRANCISCO AVE	SUITE E	WILLITS	CA	95490	3957	23	06045	39.40751637	-123.3517539	Mendocino County
75163	Fee-for-Service	1871555649	1871555649	1	1	JAKSHA, JONATHAN A MD	10/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92436	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
75220	Fee-for-Service	1497924468	1497924468	1	1	JANDA, PAUL H DO	10/11/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
75249	Fee-for-Service	1679651152	1679651152	1	1	JANG, JAMES J MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73174	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
75267	Fee-for-Service	1881096931	1881096931	1	1	JAMES P WALSH LMFT INC.	3/13/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	SUITE 102	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
75299	Fee-for-Service	1215093612	1215093612	1	1	JANSSENST JAMES, JENNIFER A	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
75301	Fee-for-Service	1912620022	1912620022	1	1	JACKSON, TANAGRA NP	5/20/2024	363L00000X	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
75307	Fee-for-Service	1174605349	1174605349	1	1	JUSTE, FRANCK MD	11/30/1992	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	66402	None	None	0	In state provider	None	9676 LAS TUNAS DR	None	TEMPLE CITY	CA	91780	2160	19	06037	34.1070343	-118.0582458	Los Angeles County
75409	Fee-for-Service	1306188412	1306188412	1	1	JARMAN, ANGELA F MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155915	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
75487	Fee-for-Service	1700818697	1700818697	1	1	JENSEN, ERIC	8/1/2024	207PE0004X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
75555	Fee-for-Service	1881096931	1881096931	1	1	JAMES P WALSH LMFT INC.	9/2/2024	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	SUITE 102	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
75557	Fee-for-Service	1144350315	1144350315	1	1	JUAN, MICHAEL A PHD	2/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2496 E ST	STE 2A	SAN DIEGO	CA	92102	6208	37	06073	32.71480484	-117.1404023	San Diego County
75567	Fee-for-Service	1174701429	1174701429	1	1	JEONG, HEESOO	9/24/2012	207R00000X	NA	Other	026	PHYSICIANS	105825	None	None	0	In state provider	None	2675 W OLYMPIC BLVD	STE 202	LOS ANGELES	CA	90006	2880	19	06037	34.05243942	-118.2907458	Los Angeles County
75573	Fee-for-Service	1679766331	1679766331	1	1	JIMENEZ, MICHAEL A MD	5/15/2018	208600000X	NA	General Surgery	026	PHYSICIANS	120714	02	General Surgery	0	In state provider	None	160 E. ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
75622	Fee-for-Service	1194706242	1194706242	1	1	JASKI, BRIAN ERNEST MD	7/1/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55011	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
75656	Fee-for-Service	1447879440	1447879440	1	1	JIANG, TIMOTHY MD	4/7/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	183375	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
75666	Fee-for-Service	1912138587	1912138587	1	1	JORSTAD, KATIE M R LCSW	8/13/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E SAN MARCOS BLVD	STE 400	SAN MARCOS	CA	92069	2988	37	06073	33.1409605	-117.162486	San Diego County
75722	Fee-for-Service	1396712717	1396712717	1	1	JOSHUA ZEIDLER, DO	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
75753	Fee-for-Service	1912102930	1912102930	1	1	JACINTO, DEANNA LMFT	10/19/2023	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
75774	Fee-for-Service	1649316035	1649316035	1	1	JARJOUR, LAMYA T MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43476	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
75783	Fee-for-Service	1942813514	1942813514	1	1	JACOBSON, JANIS D CNP	2/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
75806	Fee-for-Service	1154777415	1154777415	1	1	JOHNSON, ADAM MD	1/1/2020	207P00000X	NA	Other	026	PHYSICIANS	158728	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
75862	Fee-for-Service	1679766331	1679766331	1	1	JIMENEZ, MICHAEL A MD	5/15/2018	208600000X	NA	General Surgery	026	PHYSICIANS	120714	89	Surgery-Traumatic	0	In state provider	None	160 E. ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
75867	Fee-for-Service	1073515292	1073515292	1	1	JANCARIK, JOHN P MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127734	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
75904	Fee-for-Service	1942713201	1942713201	1	1	JOSEPH, DAPHNIE C	7/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2031 MCDANIEL ST	STE 210	N LAS VEGAS	NV	89030	0102	00	None	36.19740597	-115.1207123	Clark County
75906	Fee-for-Service	1225262421	1225262421	1	1	JONG, KIMBERLY A	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123472	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
75966	Fee-for-Service	1750538856	1750538856	1	1	JAIME FAWCETT	8/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 SIVLEY RD SW	None	HUNTSVILLE	AL	35801	4421	00	None	34.72122889	-86.58120307	Madison County
76012	Fee-for-Service	1457571531	1457571531	1	1	JEANNIE KYUNGSUN KWON, 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	0000	00	None	32.812245	-96.841584	Dallas County
76092	Fee-for-Service	1235675349	1235675349	1	1	JINGOZIAN, VARDUI LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10718 WHITE OAK AVE.	6	GRANADA HILLS	CA	91344	4628	19	06037	34.265538	-118.519724	Los Angeles County
76143	Fee-for-Service	1699885137	1699885137	1	1	JERKINS, GREGORY L MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54308	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 SANTA MARIA WAY	BLDG A	SANTA MARIA	CA	93455	2118	42	06083	34.90914521	-120.4339538	Santa Barbara County
76262	Fee-for-Service	1942788823	1942788823	1	1	JUAN, JUSTIN MD	4/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186273	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
76319	Fee-for-Service	1255396461	1255396461	1	1	JOHN C PACK OD & BEVERLY	8/28/2007	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BIANES OD INC	374 E H ST	STE 1708	CHULA VISTA	CA	91910	7492	37	06073	32.64037799	-117.0489675	San Diego County
76354	Fee-for-Service	1184704355	1184704355	1	1	JOYNER, JAMES L MD	7/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	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
76446	Fee-for-Service	1932345626	1932345626	1	1	JOHNSTON, JUDITH V 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
76498	Fee-for-Service	1629424460	1629424460	1	1	JIMENEZ, ISMAEL NP	5/11/2018	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
76598	Fee-for-Service	1679563241	1679563241	1	1	JOSHI, RITU MD	4/11/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6867 W CHARLESTON BLVD	STE B	LAS VEGAS	NV	89117	1669	00	None	36.1589907	-115.2460395	Clark County
76638	Fee-for-Service	1982934212	1982934212	1	1	JAIME ORTEGA	1/11/2010	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5142 LA SIERRA AVE	None	RIVERSIDE	CA	92505	2527	33	06065	33.92416578	-117.4918395	Riverside County
76708	Fee-for-Service	1821708694	1821708694	1	1	JUDITH LUCIA I. ALBANO, A MA	12/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RRIAGE AND FAMILY THERAP	80 EUREKA DRIVE	SUITE 215	PACIFICA	CA	94044	2677	41	06081	37.6325943	-122.488748	San Mateo County
76734	Fee-for-Service	1255407409	1255407409	1	1	JOSHI, HASMUKH G MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	33905	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
76799	Fee-for-Service	1225035793	1225035793	1	1	JONES, MATTHEW R MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80723	18	Ophthalmology	0	In state provider	None	252 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817172	-121.6460689	Monterey County
76804	Fee-for-Service	1346218740	1346218740	1	1	JEEREDDI, PRAVEENA MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76313	41	Internal Medicine	0	In state provider	None	160 E ARTESIA ST	STE 250	POMONA	CA	91767	2921	19	06037	34.07556833	-117.7507835	Los Angeles County
76872	Fee-for-Service	1194306118	1194306118	1	1	JACKSON, EVAN G MD	7/26/2024	208M00000X	NA	Other	026	PHYSICIANS	None	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
76896	Fee-for-Service	1821089137	1821089137	1	1	JONES, DAVID A MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68822	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
76898	Fee-for-Service	1669955837	1669955837	1	1	JOHNSON, DAVID K PHD	11/1/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
76929	Fee-for-Service	1982934212	1982934212	1	1	JAIME ORTEGA	1/11/2010	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5142 LA SIERRA AVE	None	RIVERSIDE	CA	92505	2527	33	06065	33.92416578	-117.4918395	Riverside County
76987	Fee-for-Service	1356416408	1356416408	1	1	JACOBSON, EUGENIA J MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56064	None	None	0	In state provider	JACOBSON PEDIATRICS PROF	7910 FROST ST	STE 335	SAN DIEGO	CA	92123	2735	37	06073	32.80027449	-117.153846	San Diego County
77002	Fee-for-Service	1902803752	1902803752	1	2	JOBET CORPORATION	1/16/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	601 S BRAND BLVD	SUITE 312	SAN FERNANDO	CA	91340	4069	19	06037	34.27854612	-118.4441844	Los Angeles County
77035	Fee-for-Service	1538300926	1538300926	1	1	JULIE L VILLARI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 JAMES SIMPSON JR WA	None	COVINGTON	KY	41011	0801	00	None	39.0715176	-84.51775131	Kenton County
77078	Fee-for-Service	1013160480	1013160480	1	1	JOSHUA, ALFRED A MD	7/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105792	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77082	Fee-for-Service	1346308756	1346308756	1	1	JOHNSON, VEASSA GAIL MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	32489	41	Internal Medicine	0	In state provider	None	231 W VERNON AVE	STE 202	LOS ANGELES	CA	90037	2779	19	06037	34.0038305	-118.2774195	Los Angeles County
77111	Fee-for-Service	1275923492	1275923492	1	1	JOO, SARAH MD	2/23/2024	207L00000X	NA	Other	026	PHYSICIANS	157035	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
77182	Fee-for-Service	1952329831	1952329831	2	1	JACKSON ROUTSON	4/11/2018	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
77190	Fee-for-Service	1790961936	1790961936	1	1	JACOBS-MARSHALL, SHERI L LMF	3/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35 HAMPSHIRE DR	None	CHICO	CA	95926	7785	04	06007	39.7283045	-121.8650062	Butte County
77218	Fee-for-Service	1700296886	1700296886	1	1	JABAJI, RAMZI B MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138379	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
77273	Fee-for-Service	1285754762	1285754762	1	1	JACHNIEWICZ, BARBARA NP	10/19/2011	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
77289	Fee-for-Service	1124289814	1124289814	1	1	JONES, EMLYN S MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106415	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
77373	Fee-for-Service	1346308756	1346308756	1	1	JOHNSON, VEASSA GAIL MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	32489	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	231 W VERNON AVE	STE 202	LOS ANGELES	CA	90037	2779	19	06037	34.0038305	-118.2774195	Los Angeles County
77379	Fee-for-Service	1124641436	1124641436	1	1	JASWAL, JESSICA DPM	5/15/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	10353 TORRE AVE	None	CUPERTINO	CA	95014	3217	43	06085	37.31739526	-122.0293011	Santa Clara County
77411	Fee-for-Service	1104871433	1104871433	1	1	JOSEPH M OKOLO M.D.	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
77483	Fee-for-Service	1861164642	1861164642	1	1	JOMOC, CAITLIN V OD	8/26/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	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
77535	Fee-for-Service	1437469269	1437469269	1	1	JOHNSON, TIFFANY D NP	7/5/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	900 S FIGUEROA	#503	LOS ANGELES	CA	90015	3918	19	06037	34.04597069	-118.2630294	Los Angeles County
77609	Fee-for-Service	1467544650	1467544650	1	1	JUROW, ANDREW H MD	4/2/1981	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31806	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1828 EL CAMINO REAL	STE 705	BURLINGAME	CA	94010	3122	41	06081	37.59552262	-122.3838771	San Mateo County
77706	Fee-for-Service	1184750622	1184750622	1	1	JAMESON, HEATHER A LPCC	11/23/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
77727	Fee-for-Service	1033278858	1033278858	1	1	JOHANSSON-MATTHEWS, INDRA R	6/2/2004	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
77829	Fee-for-Service	1194827428	1194827428	1	1	JOHNSTON, NANCY E LMFT	5/6/2020	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
77871	Fee-for-Service	1366971913	1366971913	1	1	JANDA, BRIAN A MD	9/16/2022	207L00000X	NA	Other	026	PHYSICIANS	172581	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
77911	Fee-for-Service	1982868519	1982868519	1	1	JAMES N. BOGERT MD	10/3/2015	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
77996	Fee-for-Service	1053433433	1053433433	1	1	JOHNSON, JESSICA L LCSW	6/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
78019	Fee-for-Service	1689192049	1689192049	1	1	JOHNS, JAMESINA NP	7/13/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14393 PARK AVE	STE 200	VICTORVILLE	CA	92392	3302	36	06071	34.5123	-117.3248825	San Bernardino County
78024	Fee-for-Service	1306282421	1306282421	1	1	JOLIS, TIMOTHY W MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149206	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
78029	Fee-for-Service	1013360254	1013360254	1	1	JAYAPAL, PRAVEEN MD	6/8/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172582	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78039	Fee-for-Service	1992729974	1992729974	1	1	JASON GREER	8/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1423 N JEFFERSON AVE	None	SPRINGFIELD	MO	65802	1917	00	None	37.22492991	-93.28917587	Greene County
78056	Fee-for-Service	1891035259	1891035259	1	1	JIMENEZ, MEGAN M LMFT	11/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
78081	Fee-for-Service	1629430855	1629430855	1	1	JOHNSON, CHRISTINA A MD	5/8/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167656	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78109	Fee-for-Service	1871855114	1871855114	1	1	JANG, ELAINE NP	8/25/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
78114	Fee-for-Service	1275779399	1275779399	1	1	JONES, CAMERON L MD	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106303	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
78155	Fee-for-Service	1558982512	1558982512	1	1	JEONG, MATTHEW MD	10/17/2024	207R00000X	NA	Other	026	PHYSICIANS	190535	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
78173	Fee-for-Service	1699828921	1699828921	1	1	JOHN D BRINSON	4/27/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3600 SIERRA RDG	APT 8102	RICHMOND	CA	94806	5438	07	06013	37.98706624	-122.3193088	Contra Costa County
78176	Fee-for-Service	1356386247	1356386247	1	1	J WU MEDICAL CARE INC	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70880	41	Internal Medicine	0	In state provider	None	3845 ATLANTIC AVE	None	LONG BEACH	CA	90807	3505	19	06037	33.828426	-118.185106	Los Angeles County
78202	Fee-for-Service	1992744411	1992744411	1	1	JORGENSEN, MATTHEW J PHD	5/13/2008	103TC0700X	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
78210	Fee-for-Service	1598835167	1598835167	1	1	JOHNSON, MARGERY R MD	5/20/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	172833	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
78251	Fee-for-Service	1922047612	1922047612	1	1	JACKMAN, ROBERT P MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2800 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1107	00	None	42.25189555	-121.7858276	Klamath County
78275	Fee-for-Service	1497807614	1497807614	1	1	JABER, AILEEN JADALLAH	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
78284	Fee-for-Service	1023192101	1023192101	1	1	JACOBSON, LESTER B MD	1/6/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15026	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2100 WESBSTER	STE 516	SAN FRANCISCO	CA	94115	2382	38	06075	37.7904826	-122.4324477	San Francisco County
78428	Fee-for-Service	1154386290	1154386290	1	1	JANOSKI, MAURO C MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54846	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
78469	Fee-for-Service	1184634909	1184634909	1	1	JENNIFER HIMMEL SALCH D.O	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	736 BATTLEFIELD BLVD N	None	CHESAPEAKE	VA	23320	4941	00	None	36.74619744	-76.24489616	Chesapeake city
78546	Fee-for-Service	1912293671	1912293671	1	1	JI, DONG	7/25/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78569	Fee-for-Service	1023192101	1023192101	1	1	JACOBSON, LESTER B MD	1/6/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15026	01	General Practice	0	In state provider	None	2100 WESBSTER	STE 516	SAN FRANCISCO	CA	94115	2382	38	06075	37.7904826	-122.4324477	San Francisco County
78592	Fee-for-Service	1427437029	1427437029	1	1	JAFARY, HAMED DPM	12/12/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	12520 MAGNOLIA BLVD	#304	VALLEY VILLAGE	CA	91607	2355	19	06037	34.16485451	-118.406106	Los Angeles County
78641	Fee-for-Service	1063471001	1063471001	1	1	JOSEPH H DELANEY MD	9/7/2016	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
78715	Fee-for-Service	1154386290	1154386290	1	1	JANOSKI, MAURO C MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54846	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
78795	Fee-for-Service	1518011097	1518011097	1	1	J & D HEALTHSYSTEMS INC	4/28/1998	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1504 S BROADWAY	None	SANTA MARIA	CA	93454	7214	42	06083	34.933788	-120.4359125	Santa Barbara County
78815	Fee-for-Service	1487315636	1487315636	1	1	JJAM INTERNATIONAL INC	6/14/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	44100 MONTEREY AVE	STE 216-6	PALM DESERT	CA	92260	7701	33	06065	33.728031	-116.391063	Riverside County
78941	Fee-for-Service	1447918545	1447918545	1	1	JALLOH, MARIAMA PT	1/31/2024	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
78976	Fee-for-Service	1033473533	1033473533	1	1	JAFROODI, ELHAM CNP	8/15/2019	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
78992	Fee-for-Service	1124386016	1124386016	1	1	JIANG, MEI MD	12/28/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
79082	Fee-for-Service	1164857801	1164857801	1	1	JIMENEZ, MARISOL LCSW	6/17/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	83726	-	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
79189	Fee-for-Service	1598730343	1598730343	1	1	JONES, BARCLAY 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	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
79267	Fee-for-Service	1851462600	1851462600	1	1	JONES, KENNETH L MD	8/24/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	34751	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
79269	Fee-for-Service	1508957986	1508957986	1	1	JOYCE, VIRGINIA MD	2/28/1991	208600000X	NA	General Surgery	026	PHYSICIANS	61495	78	Neoplastic Diseases/Oncology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
79388	Fee-for-Service	1821717737	1821717737	1	1	JUNG, LAUREN LCSW	1/30/2023	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
79405	Fee-for-Service	1518072230	1518072230	1	1	JUKAKU, FAHEEM M MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72490	08	Family Practice	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
79505	Fee-for-Service	1487288338	1487288338	1	1	JBNS CONSULTING LLC	2/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16700 VALLEY VIEW AVE	STE 300	LA MIRADA	CA	90638	5830	19	06037	33.87993557	-118.028767	Los Angeles County
79518	Fee-for-Service	1053362251	1053362251	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
79530	Fee-for-Service	1720076912	1720076912	1	1	JANOWITZ, TOBY D	1/1/1997	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	525 COMMERCE AVE	STE B	PALMDALE	CA	93551	4487	19	06037	34.58960447	-118.1406825	Los Angeles County
79554	Fee-for-Service	1710063573	1710063573	1	1	JURKOVICH, GREGORY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	141002	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
79557	Fee-for-Service	1508957986	1508957986	1	1	JOYCE, VIRGINIA MD	2/28/1991	208600000X	NA	General Surgery	026	PHYSICIANS	61495	02	General Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
79569	Fee-for-Service	1205246501	1205246501	1	1	JAMES, JANESSA A MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141285	40	Pediatrics	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
79599	Fee-for-Service	1730385428	1730385428	1	1	JURGENS, ANDREA L	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
79616	Fee-for-Service	1548236292	1548236292	1	1	JANE K WILLETT	10/26/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	112 SAINT OLAF AVE S	None	CANBY	MN	56220	1433	00	None	44.70763388	-96.27792114	Yellow Medicine County
79778	Fee-for-Service	1215011069	1215011069	1	1	JONES, JOHN K MD	11/19/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
79794	Fee-for-Service	1487288338	1487288338	1	1	JBNS CONSULTING LLC	2/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16700 VALLEY VIEW AVE	STE 300	LA MIRADA	CA	90638	5830	19	06037	33.87993557	-118.028767	Los Angeles County
79843	Fee-for-Service	1679525323	1679525323	1	1	JOHNSON, STEVEN M MD	7/30/1991	207L00000X	NA	Other	026	PHYSICIANS	50511	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
79900	Fee-for-Service	1629502554	1629502554	1	1	JK PHARMACY INC	7/12/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5562 PHILADELPHIA ST	STE 110	CHINO	CA	91710	2482	36	06071	34.03370384	-117.6837291	San Bernardino County
79980	Fee-for-Service	1447279971	1447279971	1	1	JEAN, WENNY MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	89142	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
79994	Fee-for-Service	1871840694	1871840694	1	1	JACKSON, KATIE CCC-SLP	1/27/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1849 WILLOW PASS RD.	SUITE 420	CONCORD	CA	94520	2524	07	06013	37.97486759	-122.0377305	Contra Costa County
80047	Fee-for-Service	1689690539	1689690539	1	1	JACKSON, GEORGE R MD	3/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	53511	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
80078	Fee-for-Service	1205982071	1205982071	1	1	JAY, SANDRA L NP	4/9/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
80148	Fee-for-Service	1730175647	1730175647	1	1	JAFRY, AMNA A MD	10/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	161827	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
80480	Fee-for-Service	1447543160	1447543160	1	1	JOSEPH, GAIL R L MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143359	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1234 E NORTH STREET	SUITE 102	MANTECA	CA	95336	4961	39	06077	37.80105524	-121.1968581	San Joaquin County
80567	Fee-for-Service	1811197734	1811197734	1	1	JAIN, SUMESH MD	7/1/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161907	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
80637	Fee-for-Service	1427072362	1427072362	1	1	JACINTO, JOSEFINA MD	9/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	40275	40	Pediatrics	0	In state provider	None	2143 W ORANGEWOOD AVE	None	ORANGE	CA	92868	1941	30	06059	33.79581651	-117.875781	Orange County
80760	Fee-for-Service	1902538580	1902538580	1	2	JACKSON-ZUCKERMAN INC	12/9/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TES	415 HOSPITAL DRIVE	None	UKIAH	CA	95482	4545	23	06045	39.15408161	-123.2020675	Mendocino County
80779	Fee-for-Service	1265401988	1265401988	1	1	JENSEN, JACLYN A DO	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9415	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
80919	Fee-for-Service	1932269396	1932269396	1	1	JACOB, SUMA MD	12/27/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
80938	Fee-for-Service	1871116004	1871116004	1	1	JACOBSEN, JACE D CRNA	5/24/2021	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
81121	Fee-for-Service	1477558633	1477558633	2	1	JAMECO HOME HEALTH AGENCY	7/9/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2377 W FOOTHILL BLVD	SUITE 16	UPLAND	CA	91786	3577	36	06071	34.10690963	-117.6975663	San Bernardino County
81124	Fee-for-Service	1295813392	1295813392	1	1	JOHANNESSEN, HELGE MD	9/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52478	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
81135	Fee-for-Service	1528148848	1528148848	1	1	JOHNSON, LISA M MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112803	40	Pediatrics	0	In state provider	None	6555 COYLE AVE	STE 200	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
81284	Fee-for-Service	1568982031	1568982031	1	1	JREIJE, DIANA N DO	5/4/2021	207R00000X	NA	Other	026	PHYSICIANS	16676	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
81287	Fee-for-Service	1306947981	1306947981	1	1	JONH L. REED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7441 O ST	STE 200	LINCOLN	NE	68510	2468	00	None	40.8133627	-96.61786305	Lancaster County
81388	Fee-for-Service	1699267054	1699267054	1	1	JOHNSTON, KARLY LMFT	9/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16052 BEACH BLVD STE 218	None	HUNTINGTON BEACH	CA	92647	3809	30	06059	33.72949639	-117.989162	Orange County
81406	Fee-for-Service	1275822363	1275822363	1	1	JOHNS, JASON R MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122257	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81541	Fee-for-Service	1134979743	1134979743	1	1	JAVAID, REESHA NP	6/4/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95029483	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
81603	Fee-for-Service	1255315677	1255315677	1	1	JABLECKI, CHARLES K MD	5/1/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	33067	13	Neurology (M.D. only)	0	In state provider	None	550 WASHINGTON ST	STE 221	SAN DIEGO	CA	92103	2269	37	06073	32.75003652	-117.1603431	San Diego County
81743	Fee-for-Service	1295266757	1295266757	2	1	JAIN, KAVITA MD	9/19/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175247	09	Gynecology (D.O. only)	0	In state provider	None	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
81761	Fee-for-Service	1174528004	1174528004	1	1	JOHNSON,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	9305 W THOMAS RD	STE 155	PHOENIX	AZ	85037	3360	00	None	33.47802	-112.2604065	Maricopa County
81825	Fee-for-Service	1750306718	1750306718	1	1	JANG, CATHY J L MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81225	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
81857	Fee-for-Service	1871913285	1871913285	1	1	JOSEPH, JOHN P MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143393	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
81933	Fee-for-Service	1003308990	1003308990	1	1	JAFARI, MOEIN MD	3/13/2025	207RH0003X	NA	Oncology	026	PHYSICIANS	None	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
81973	Fee-for-Service	1518947308	1518947308	1	1	JACOBY, GEOFFREY S MD	12/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53774	None	None	0	In state provider	None	3100 WARNER	None	SANTA ANA	CA	92704	5331	30	06059	33.715124	-117.9105585	Orange County
82032	Fee-for-Service	1629331988	1629331988	1	1	JANAKIRAMAN, VENKATESH MD	12/12/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	140162	13	Neurology (M.D. only)	0	In state provider	None	1705 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477999	-119.0215335	Kern County
82038	Fee-for-Service	1730657057	1730657057	1	1	JIMENEZ, CHRISTOPHER T LMFT	4/15/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106986	-	NOT APPLICABLE	0	In state provider	None	1200 NORTH MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3640	30	06059	33.755175	-117.8676195	Orange County
82047	Fee-for-Service	1407881741	1407881741	1	1	JOHNSON, KURT E MD	10/1/1995	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	59768	01	General Practice	0	In state provider	None	1040 MANGROVE AVE	None	CHICO	CA	95926	3509	04	06007	39.7403994	-121.8373152	Butte County
82117	Fee-for-Service	1972931798	1972931798	1	2	JOHN SWETT UNIFIED SCHOOL	11/25/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	400 PARKER AVE	None	RODEO	CA	94572	1400	07	06013	38.03275511	-122.2671019	Contra Costa County
82125	Fee-for-Service	1063641017	1063641017	1	1	JATWANI, SHRADDHA MD	12/14/2022	207RR0500X	NA	Other	026	PHYSICIANS	181334	None	None	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
82143	Fee-for-Service	1417008772	1417008772	1	1	JARCHI, SHAHRIAR MD	3/6/2008	207R00000X	NA	Other	026	PHYSICIANS	96880	41	Internal Medicine	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
82156	Fee-for-Service	1366872293	1366872293	1	1	JHORAR, PREETI MD	7/2/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	158174	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
82217	Fee-for-Service	1578127767	1578127767	1	1	JOHNSON, COURTNEY E NP	12/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
82232	Fee-for-Service	1104937572	1104937572	1	1	JS SONI MD FACC APC	1/29/2008	207R00000X	NA	Other	026	PHYSICIANS	42276	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2161 COLORADO AVE	SUITE D	TURLOCK	CA	95382	2007	50	06099	37.51254293	-120.8353135	Stanislaus County
82253	Fee-for-Service	1306224738	1306224738	1	1	JACOBSON, NICHOLAS D MD	11/15/2018	390200000X	NA	Other	026	PHYSICIANS	148414	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
82274	Fee-for-Service	1245492701	1245492701	1	1	JONUTZ, CLINT CP	5/15/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3838 WATT AVE	STE A110	SACRAMENTO	CA	95821	2689	34	06067	38.635902	-121.381821	Sacramento County
82319	Fee-for-Service	1073680815	1073680815	1	1	JACOBSON, GARY J OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3401 S HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
82320	Fee-for-Service	1700811312	1700811312	1	1	JAHNKE, EDWARD J III MD	10/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46668	30	Radiology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
82347	Fee-for-Service	1346024783	1346024783	1	1	JAMIL, SAMI PT	1/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2820 BELLFLOWER BLVD	None	LONG BEACH	CA	90815	1125	19	06037	33.80733578	-118.125179	Los Angeles County
82362	Fee-for-Service	1255536140	1255536140	1	1	JENSEN, CHRISTOPHER A PHD	4/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
82405	Fee-for-Service	1972931798	1972931798	1	2	JOHN SWETT UNIFIED SCHOOL	4/1/2023	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	400 PARKER AVE	None	RODEO	CA	94572	1400	07	06013	38.03275511	-122.2671019	Contra Costa County
82419	Fee-for-Service	1629042650	1629042650	1	1	JONES, BONITA L MD	4/4/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52429	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
82444	Fee-for-Service	1366872293	1366872293	1	1	JHORAR, PREETI MD	7/2/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	158174	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
82464	Fee-for-Service	1114042157	1114042157	1	1	JUSIC, DALILA MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50561	-	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
82486	Fee-for-Service	1952414054	1952414054	1	1	JENG, GRACE OD	10/21/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
82503	Fee-for-Service	1275509390	1275509390	1	1	JAMES,MARK 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	3033 S PARKER RD	STE #800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
82530	Fee-for-Service	1003378787	1003378787	1	1	JOSE, JENNIFER	1/4/2023	207R00000X	NA	Other	026	PHYSICIANS	183335	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
82546	Fee-for-Service	1811907439	1811907439	1	1	JOSHI, SUCHETA MD	1/25/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	56407	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
82628	Fee-for-Service	1710973839	1710973839	1	1	JAIN, SANJEEV MD	11/30/2023	207K00000X	NA	Other	026	PHYSICIANS	88329	None	None	0	In state provider	None	2940 SUMMIT ST	STE 1	OAKLAND	CA	94609	3410	01	06001	37.81849213	-122.2647718	Alameda County
82633	Fee-for-Service	1073591012	1073591012	1	1	JACKSON, CHRISTOPHER A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	SAINT PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
82698	Fee-for-Service	1518094952	1518094952	1	1	JULIEN, PETER J MD	9/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33700	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
82699	Fee-for-Service	1306289129	1306289129	1	1	JACK, RICHARD A MD	10/18/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	175889	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
82761	Fee-for-Service	1699859694	1699859694	1	1	JAMES, DANELLE F MD	9/15/2008	207R00000X	NA	Other	026	PHYSICIANS	87489	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
82835	Fee-for-Service	1043866494	1043866494	1	1	JOHARCHI, HANNAH PHD	12/24/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
82842	Fee-for-Service	1285959114	1285959114	1	1	JOSHUA VANDERSTEEN	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6028 S RIDGELINE DR	STE 205	OGDEN	UT	84405	6912	00	None	41.153508	-111.942374	Weber County
82881	Fee-for-Service	1558998120	1558998120	1	1	JIMENEZ, CECILIA MD	12/15/2023	390200000X	NA	Other	026	PHYSICIANS	182714	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
82894	Fee-for-Service	1114471786	1114471786	1	1	JONES, ALEXANDRIA D LMFT	1/17/2023	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
82899	Fee-for-Service	1528301918	1528301918	1	1	JORDAN, TRESSA M DPM	2/22/2022	213E00000X	NA	Other	027	PODIATRISTS	-	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
83047	Fee-for-Service	1699859694	1699859694	1	1	JAMES, DANELLE F MD	9/15/2008	207R00000X	NA	Other	026	PHYSICIANS	87489	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
83080	Fee-for-Service	1114156155	1114156155	1	1	JAMES E BURHOP	10/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
83114	Fee-for-Service	1144337130	1144337130	1	1	JOHN FRANKA MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
83149	Fee-for-Service	1023646247	1023646247	1	1	JIANG, SHIRLEY Y MD	5/7/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	187656	03	Allergy	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
83247	Fee-for-Service	1598893794	1598893794	1	1	JINDAL, RAKESH MD INC	9/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SIERRA FOOTHILLS MED GRP	462 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3321	54	06107	36.06958973	-119.0272824	Tulare County
83438	Fee-for-Service	1023646247	1023646247	1	1	JIANG, SHIRLEY Y MD	5/7/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	187656	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
83440	Fee-for-Service	1215015300	1215015300	1	1	JORDAN, MICHAEL J MD	7/18/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	45265	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	50 ALESSANDRO PL	STE 420	PASADENA	CA	91105	3173	19	06037	34.13101049	-118.151532	Los Angeles County
83456	Fee-for-Service	1497720247	1497720247	1	1	JAFFE, JAMES W MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149481	30	Radiology	0	In state provider	None	3900 GEER ROAD	None	TURLOCK	CA	95382	1147	50	06099	37.52828715	-120.8488829	Stanislaus County
83513	Fee-for-Service	1669140927	1669140927	1	1	JANMOHAMED, TASLIM OT	10/25/2021	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
83515	Fee-for-Service	1740227008	1740227008	1	1	JERRY W. CHELLINI	2/21/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 S GRANT AVE	None	COLUMBUS	OH	43215	4701	00	None	39.96098228	-82.99064295	Franklin County
83522	Fee-for-Service	1386105369	1386105369	1	1	JOVEL, IRIS MD	9/8/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179751	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
83550	Fee-for-Service	1720159783	1720159783	1	1	JAFFE, PAUL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38147	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
83593	Fee-for-Service	1629121264	1629121264	1	1	JIE, JIMMY	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	18557 SHERMAN WAY	None	RESEDA	CA	91335	4144	19	06037	34.20120553	-118.537911	Los Angeles County
83660	Fee-for-Service	1881733806	1881733806	1	1	JOSE PABLO STERLING, 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	7208	00	None	32.812245	-96.841584	Dallas County
83768	Fee-for-Service	1952543746	1952543746	1	1	JOSLIN, MELISSA A PSYD	3/1/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
83799	Fee-for-Service	1508855594	1508855594	1	1	JACKSON, JAMES R MD JR	9/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93680	41	Internal Medicine	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
83939	Fee-for-Service	1164652806	1164652806	1	1	JOHNSON, JENNIFER LMFT	5/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
83954	Fee-for-Service	1497733687	1497733687	1	1	JOLIKIM HOME HEALTH SVS INC	2/24/1988	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	914 N GLENDALE AVE	None	GLENDALE	CA	91206	2129	19	06037	34.15930258	-118.2393182	Los Angeles County
84083	Fee-for-Service	1033521414	1033521414	1	1	JOHNSON, KYLE E	8/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	156544	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
84233	Fee-for-Service	1518081652	1518081652	1	1	JPB MEDICAL GROUP	5/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CENTURY MEDICAL GROUP	15243 VANOWEN ST	STE 406	VAN NUYS	CA	91405	3655	19	06037	34.19394848	-118.4654115	Los Angeles County
84280	Fee-for-Service	1225033020	1225033020	1	1	JACKSON MEMORIAL HOSP	4/11/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1611 NW 12TH AVE	None	MIAMI	FL	33136	1005	00	None	25.791939	-80.212698	Miami-Dade County
84297	Fee-for-Service	1124524244	1124524244	1	1	JANCHENKO, LAUREN M NP	7/17/2018	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
84309	Fee-for-Service	1275114423	1275114423	1	1	JI, HYEIN MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	183243	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
84326	Fee-for-Service	1003852039	1003852039	1	1	JOHNNY CAMPBELL MD	10/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	316 CALHOUN ST	None	CHARLESTON	SC	29401	1113	00	None	32.782896	-79.9495875	Charleston County
84330	Fee-for-Service	1114134699	1114134699	1	1	JEONG, HELEN MD	5/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18838	None	None	0	In state provider	None	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	27	06053	36.61275747	-121.9010674	Monterey County
84348	Fee-for-Service	1497736177	1497736177	1	1	JACOBSON, MICHAEL C MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	97915	None	None	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
84565	Fee-for-Service	1225033020	1225033020	1	1	JACKSON MEMORIAL HOSP	9/12/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1611 NW 12TH AVE	None	MIAMI	FL	33136	1005	00	None	25.791939	-80.212698	Miami-Dade County
84730	Fee-for-Service	1154401552	1154401552	1	1	JENKINS, LOUIS E	9/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11130 ANDERSON ST	STE 102	LOMA LINDA	CA	92354	2802	36	06071	34.05167746	-117.2614612	San Bernardino County
84781	Fee-for-Service	1881344950	1881344950	1	1	JAHED, MADINA	9/20/2024	390200000X	NA	Other	026	PHYSICIANS	190652	27	Psychiatry Neurology (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
84816	Fee-for-Service	1669731576	1669731576	1	1	JV PHARMACY & MEDICAL SUPPLY	9/13/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1357 E LOS ANGELES	AVE C	SIMI VALLEY	CA	93065	2033	56	06111	34.273638	-118.7734545	Ventura County
84850	Fee-for-Service	1205085958	1205085958	1	1	JAYAKUMAR, UDAI M MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130571	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
84885	Fee-for-Service	1477358331	1477358331	1	1	JOSE B CONTRERAS MD PC	3/13/2025	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18837 BROOKHURST ST	110	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
84927	Fee-for-Service	1801824651	1801824651	1	1	JOHN CHANDLER	8/30/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	815 S PINE STREET	None	VIVIAN	LA	71082	3314	00	None	32.8635682	-93.98775781	Caddo Parish
84972	Fee-for-Service	1225589112	1225589112	1	1	JOHNSON, JUNKO LMFT	1/23/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25255 CABOT RD	228	LAGUNA HILLS	CA	92653	5519	30	06059	33.59595988	-117.6763288	Orange County
84996	Fee-for-Service	1376109595	1376109595	1	1	JENKINS, DANIEL H DO	5/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22040	08	Family Practice	0	In state provider	None	8036 SAN MIGUEL CANYON R	None	PRUNEDALE	CA	93907	1208	27	06053	36.8007891	-121.6653293	Monterey County
85006	Fee-for-Service	1558304774	1558304774	1	1	JAHAN, REZA	3/2/2004	2085R0204X	NA	Other	026	PHYSICIANS	76584	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
85011	Fee-for-Service	1285223552	1285223552	1	1	JIVA HEALTH, INC	12/16/2021	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
85026	Fee-for-Service	1740479229	1740479229	1	1	JONES, JANELLE R MD	5/12/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	83227	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
85078	Fee-for-Service	1902680556	1902680556	1	1	JOSEPH, JEBY NP	9/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
85113	Fee-for-Service	1780765578	1780765578	1	1	JOYEE V SOPRANO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC EMERGENCY MD	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
85157	Fee-for-Service	1083081780	1083081780	1	1	JAMES, BLAIR E LCSW	3/30/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	66155	-	NOT APPLICABLE	0	In state provider	None	2307 W 6TH STREET	None	LOS ANGELES	CA	90057	3119	19	06037	34.06056584	-118.2771007	Los Angeles County
85161	Fee-for-Service	1093759151	1093759151	1	1	JACOBSON, ERIC D MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63250	30	Radiology	0	In state provider	None	995 SAINT JOHN PL	None	HEMET	CA	92543	4436	33	06065	33.74848448	-116.9616465	Riverside County
85163	Fee-for-Service	1346338282	1346338282	1	1	J AND P HOMES INC	2/21/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6891 SAN PEDRO CIR	None	BUENA PARK	CA	90620	2978	30	06059	33.84216692	-118.0134392	Orange County
85165	Fee-for-Service	1306088422	1306088422	1	1	JACKSON, WHITNEY E MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (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
85176	Fee-for-Service	1477358331	1477358331	1	1	JOSE B CONTRERAS MD PC	3/13/2025	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	18837 BROOKHURST ST	110	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
85300	Fee-for-Service	1285223552	1285223552	1	1	JIVA HEALTH, INC	12/16/2021	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
85386	Fee-for-Service	1134308646	1134308646	1	1	JENNIFER LYNN ANDERSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	740 MIDDLE CREEK RD	STE 200	SEVIERVILLE	TN	37862	5056	00	None	35.855955	-83.5354485	Sevier County
85425	Fee-for-Service	1811366941	1811366941	1	1	JONES, SARAH C LCSW	1/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	33	06065	33.790527	-116.4058645	Riverside County
85499	Fee-for-Service	1669495370	1669495370	1	1	JOHNSTON, SAMANTHA H MD	5/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86357	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
85536	Fee-for-Service	1578936225	1578936225	1	1	JJ KEMP ENTERPRISES	11/15/2018	225XF0002X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	PY	28991 OLD TOWN FRONT STR	SUITE 101	TEMECULA	CA	92590	2530	33	06065	33.48435441	-117.1437755	Riverside County
85538	Fee-for-Service	1821625229	1821625229	1	1	JASPERSE, NATHAN J MD	8/28/2024	207P00000X	NA	Other	026	PHYSICIANS	180970	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
85590	Fee-for-Service	1285223552	1285223552	1	1	JIVA HEALTH, INC	12/16/2021	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
85598	Fee-for-Service	1528336765	1528336765	1	3	JENNY HUNG OD INC	5/11/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 WALNUT GROVE AVE	None	ROSEMEAD	CA	91770	3789	19	06037	34.050339	-118.0842885	Los Angeles County
85728	Fee-for-Service	1679041172	1679041172	1	1	JONATHAN E THYGESON, M.D., I	6/14/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ADOLESCENT MEDICINE	755 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6708	34	06067	38.565378	-121.419567	Sacramento County
85739	Fee-for-Service	1962163022	1962163022	1	1	JACKSON, KAVONNA	8/27/2024	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
85820	Fee-for-Service	1578936225	1578936225	1	1	JJ KEMP ENTERPRISES	11/15/2018	225XF0002X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	PY	28991 OLD TOWN FRONT STR	SUITE 101	TEMECULA	CA	92590	2530	33	06065	33.48435441	-117.1437755	Riverside County
85823	Fee-for-Service	1750607073	1750607073	1	1	JIN, PETER Y MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120881	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
85852	Fee-for-Service	1225155484	1225155484	1	1	JONES, RUSSELL D MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121033	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
85858	Fee-for-Service	1023462629	1023462629	1	1	JIANG, AN-AN DPM	11/4/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
85924	Fee-for-Service	1306924238	1306924238	1	1	JOSHI, AARCHAN MD INC	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	520 N PROSPECT AVE	STE 206	REDONDO BEACH	CA	90277	3042	19	06037	33.8529819	-118.3802954	Los Angeles County
85936	Fee-for-Service	1518091040	1518091040	1	1	JUHASZ, MICHELLE LCSW	10/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
86032	Fee-for-Service	1053899252	1053899252	1	1	JONES, ALABUN'MI A LCSW	4/5/2024	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
86057	Fee-for-Service	1174707392	1174707392	1	1	JAIN, ANJALI MD	2/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104832	67	Endocrinology	0	In state provider	None	3700 CALIFORNIA ST	BASEMENT FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
86086	Fee-for-Service	1821165796	1821165796	1	1	JONES, KARIN D MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71451	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
86090	Fee-for-Service	1124884606	1124884606	1	1	JOHNSON, LANEISHA D DOULA	3/6/2025	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
86127	Fee-for-Service	1073587598	1073587598	1	1	JACKSON, WOODY H MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54085	02	General Surgery	0	In state provider	None	501 SOUTH BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
86177	Fee-for-Service	1336334945	1336334945	1	1	JONES, CYNTHIA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68790	41	Internal Medicine	0	In state provider	None	1107 WEST POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
86213	Fee-for-Service	1316036908	1316036908	1	1	JOE, JONATHAN J OD	8/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROF OPTOMETRIC CORP	20687 AMAR RD	STE 6	WALNUT	CA	91789	5045	19	06037	34.04208589	-117.8510377	Los Angeles County
86241	Fee-for-Service	1285824623	1285824623	1	1	JOHNSON, MATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 3920	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
86247	Fee-for-Service	1487679684	1487679684	1	1	JOHNSON, CARL E MD	12/4/2020	207ZP0101X	NA	Other	026	PHYSICIANS	33572	None	None	0	In state provider	None	801 E CHAPEL ST	STE 1	SANTA MARIA	CA	93454	4607	42	06083	34.9542915	-120.424455	Santa Barbara County
86276	Fee-for-Service	1467913491	1467913491	1	1	JOSHI, POOJA A	11/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
86329	Fee-for-Service	1639139967	1639139967	1	1	JONES, JOHN T MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12685	41	Internal Medicine	0	In state provider	None	350 30TH STREET	SUITE 320	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
86344	Fee-for-Service	1174707392	1174707392	1	1	JAIN, ANJALI MD	2/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104832	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	BASEMENT FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
86530	Fee-for-Service	1386647295	1386647295	1	1	JAMIESON, PETER MD	6/13/2024	174400000X	NA	Other	026	PHYSICIANS	53447	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4857	33	06065	33.839505	-116.5455735	Riverside County
86599	Fee-for-Service	1033504360	1033504360	1	1	JAHNNY, BRIAN DO	8/8/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
86601	Fee-for-Service	1477740363	1477740363	1	1	JOHNSON, DIANNA M LMFT	3/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	123779	-	NOT APPLICABLE	0	In state provider	None	68-615 PEREZ ROAD	SUITE 3A,4A,5A,6A,7A	CATHEDRAL CITY	CA	92234	7200	33	06065	33.78476619	-116.4684902	Riverside County
86603	Fee-for-Service	1447389556	1447389556	1	1	JENSEN, KEITH A CRNA	9/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
86607	Fee-for-Service	1912296989	1912296989	1	1	JOHNSON, TODD A MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
86613	Fee-for-Service	1063569135	1063569135	1	1	JOHNSTON, STACY K PHD	12/1/2001	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	501 W BROADWAY	STE 800	SAN DIEGO	CA	92101	3546	37	06073	32.71562254	-117.1677915	San Diego County
86630	Fee-for-Service	1700076239	1700076239	1	1	JEFFREY WU	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
86637	Fee-for-Service	1265720486	1265720486	1	1	JACKSON, VALERIE W PSY	7/27/2017	No Taxonomy Provided	NA	None	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
86676	Fee-for-Service	1861430092	1861430092	1	1	JOSEPH, THOMAS P MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94387	78	Neoplastic Diseases/Oncology	0	In state provider	None	16801 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7405	19	06037	34.25751298	-118.4982318	Los Angeles County
86784	Fee-for-Service	1285604702	1285604702	1	1	JENKINS, ENCHANTA L MD FACOG	2/1/2017	171000000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
86837	Fee-for-Service	1346577384	1346577384	1	1	JANNAPUREDDY, DEEPIKA MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109840	01	General Practice	0	In state provider	None	6066 CIVIC TERRACE	None	NEWARK	CA	94560	3746	01	06001	37.53623835	-122.0285012	Alameda County
86960	Fee-for-Service	1780703900	1780703900	1	1	JANSEN, JEREMIAH A MD	5/19/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175919	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
86965	Fee-for-Service	1861430092	1861430092	1	1	JOSEPH, THOMAS P MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94387	41	Internal Medicine	0	In state provider	None	16801 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7405	19	06037	34.25751298	-118.4982318	Los Angeles County
87090	Fee-for-Service	1821673062	1821673062	1	1	JEFFREY CRUDO MD CORP	9/27/2022	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1100 S COAST HWY	STE 206	LAGUNA BEACH	CA	92651	2972	30	06059	33.53413366	-117.7769071	Orange County
87113	Fee-for-Service	1467565754	1467565754	1	1	JOHNSON,GREGORY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2221 W ELM ST	None	RAWLINS	WY	82301	0000	00	None	41.78659753	-107.2613227	Carbon County
87138	Fee-for-Service	1467539312	1467539312	1	1	JUTH, ANDREA L MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72396	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
87145	Fee-for-Service	1982666152	1982666152	2	1	JEKUMS, THEODORE J MD	2/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	23626	02	General Surgery	0	In state provider	None	1801 W ROMNEYA DR	STE 404	ANAHEIM	CA	92801	1826	30	06059	33.8506615	-117.946413	Orange County
87251	Fee-for-Service	1861430092	1861430092	1	1	JOSEPH, THOMAS P MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94387	68	Hematology	0	In state provider	None	16801 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7405	19	06037	34.25751298	-118.4982318	Los Angeles County
87262	Fee-for-Service	1356715189	1356715189	1	1	JONES, KATHERINE C PA	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52856	-	NOT APPLICABLE	0	In state provider	None	1124 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	4331	01	06001	37.79106984	-122.2484928	Alameda County
87316	Fee-for-Service	1487486072	1487486072	1	1	JOHNSON, PAULA LMFT	9/9/2024	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
87429	Fee-for-Service	1679651293	1679651293	1	1	JING, WEN MD	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71708	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
87464	Fee-for-Service	1811362585	1811362585	1	1	JENNIFER A DOWALTER MD A PRO	6/1/2020	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	FESSIONAL CORPORATION	15630 18TH	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
87550	Fee-for-Service	1801037239	1801037239	2	1	JORGENSEN, SCOTT A MD	1/10/2013	No Taxonomy Provided	NA	None	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
87554	Fee-for-Service	1912022641	1912022641	1	1	JOHNSON, LEONIDAS A OD	12/7/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8301 S VERMONT AVE	STE A	LOS ANGELES	CA	90044	3470	19	06037	33.96332763	-118.2918812	Los Angeles County
87580	Fee-for-Service	1952478950	1952478950	1	1	JACKSON, LAURENCE E MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	38408	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
87600	Fee-for-Service	1871656991	1871656991	1	1	JUNG, TIFFANY	9/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
87620	Fee-for-Service	1003901992	1003901992	1	1	JARDON, GLORIA I LMFT	4/19/2021	1041C0700X	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
87636	Fee-for-Service	1710097621	1710097621	1	1	JAVANBAKHT, ALI MD	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70993	08	Family Practice	0	In state provider	None	215 PESETAS LANE	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
87658	Fee-for-Service	1679010805	1679010805	1	1	JAKKULA, SHEEBA S	11/20/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2324 MONTPELIER DR	STE 1	SAN JOSE	CA	95116	1612	43	06085	37.3648224	-121.8481115	Santa Clara County
87732	Fee-for-Service	1235200288	1235200288	1	1	JORGENSEN, MICHAEL B MD	4/27/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59769	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
87838	Fee-for-Service	1801037239	1801037239	2	1	JORGENSEN, SCOTT A MD	1/10/2013	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
87853	Fee-for-Service	1194735811	1194735811	1	1	JEANNETTE PETERSON, MD, INC	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76492	None	None	0	In state provider	None	1525 WEBSTER ST	STE 4	FAIRFIELD	CA	94533	4997	48	06095	38.2570563	-122.0475622	Solano County
87885	Fee-for-Service	1871192492	1871192492	1	1	JAYEOBA-SAMPAY, FOLASHADE	1/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3350 SHELBY STREET	STE 200	ONTARIO	CA	92335	0766	36	06071	34.069698	-117.578205	San Bernardino County
87890	Fee-for-Service	1780173849	1780173849	1	1	JOHNSON, CORY MD	5/23/2022	390200000X	NA	Other	026	PHYSICIANS	166309	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
87904	Fee-for-Service	1881679876	1881679876	1	1	JERANT, ANTHONY F MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
88019	Fee-for-Service	1235200288	1235200288	1	1	JORGENSEN, MICHAEL B MD	4/27/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59769	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
88117	Fee-for-Service	1093030470	1093030470	1	1	JAVIER RIVERA M.D	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
88191	Fee-for-Service	1881679876	1881679876	1	1	JERANT, ANTHONY F MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84582	08	Family Practice	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
88221	Fee-for-Service	1912026980	1912026980	1	1	JHEE, DENNIS SOUNG OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HARVARD OPTOMETRIC CTR	18742 E COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2916	19	06037	33.98774021	-117.8948553	Los Angeles County
88237	Fee-for-Service	1033477146	1033477146	1	1	JUSTICE, JORDAN A MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147270	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
88238	Fee-for-Service	1336185693	1336185693	1	1	JONES, WALTER D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41234	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
88250	Fee-for-Service	1801151923	1801151923	1	2	JAIN, SHREYA MD	11/14/2023	207R00000X	NA	Other	026	PHYSICIANS	136039	None	None	0	In state provider	None	1900 SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
88325	Fee-for-Service	1053646885	1053646885	1	1	JUSTIN LUGAR MD	5/18/2017	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
88340	Fee-for-Service	1336181866	1336181866	1	1	JESSY COLAH MD	7/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 6TH ST	None	BROOKLYN	NY	11215	3609	00	None	40.668219	-73.979352	Kings County
88372	Fee-for-Service	1467612648	1467612648	1	1	JEREMY HUGHES	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
88386	Fee-for-Service	1326537549	1326537549	1	1	JOSEPH COLLINS, DO, P.C.	12/17/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
88462	Fee-for-Service	1023151735	1023151735	1	1	JURIANSZ, GORDON J MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84655	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	STE 304	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
88464	Fee-for-Service	1275026080	1275026080	1	1	JAMES MUNGAI MWAURA	1/19/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3121 CHERRYDALE DR	None	DIAMOND BAR	CA	91765	3404	19	06037	33.96947581	-117.8447518	Los Angeles County
88485	Fee-for-Service	1346669116	1346669116	1	1	JOHN, ALAN K MD	9/1/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139341	None	None	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
88493	Fee-for-Service	1265649966	1265649966	1	1	JACOBSEN, GARTH R MD	7/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99668	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
88524	Fee-for-Service	1033477146	1033477146	1	1	JUSTICE, JORDAN A MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147270	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
88545	Fee-for-Service	MSS00004F	None	1	1	JEWISH FAMILY SERVICES	7/1/1998	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES	12821 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3012	19	06037	34.18670951	-118.41246	Los Angeles County
88569	Fee-for-Service	1427076090	1427076090	1	1	JACOBS, SHARI R MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71590	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
88573	Fee-for-Service	1497935266	1497935266	1	1	JOE, STANTON H MD INC	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	22872	30	Radiology	0	In state provider	None	1809 VERDUGO BLVD	STE 100	GLENDALE	CA	91208	1402	19	06037	34.20568088	-118.2154356	Los Angeles County
88610	Fee-for-Service	1477750636	1477750636	1	1	JEFFREY MAURICE REAGAN M.D.	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4830 HIGHWAY 260	STE 103	LAKESIDE	AZ	85929	5851	00	None	34.184178	-110.015451	Navajo County
88633	Fee-for-Service	1275527954	1275527954	1	1	JOAN MARY WARNER MD	9/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5505 W CHANDLER BLVD	STE B13	CHANDLER	AZ	85226	3681	00	None	33.304518	-111.937941	Maricopa County
88667	Fee-for-Service	1437589827	1437589827	1	1	JACKSON, KRISTOPHER J NP	6/19/2017	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
88752	Fee-for-Service	1275026080	1275026080	1	1	JAMES MUNGAI MWAURA	1/19/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3121 CHERRYDALE DR	None	DIAMOND BAR	CA	91765	3404	19	06037	33.96947581	-117.8447518	Los Angeles County
89074	Fee-for-Service	1396042628	1396042628	1	1	JACKSON, KIMBERLEE M MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137419	01	General Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
89126	Fee-for-Service	1235143702	1235143702	2	1	JEW, J NICHOLAS MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74351	41	Internal Medicine	0	In state provider	None	919 CLAY ST	None	SAN FRANCISCO	CA	94108	1520	38	06075	37.79398652	-122.4083496	San Francisco County
89142	Fee-for-Service	1013099936	1013099936	1	1	JAGAN N BANSAL MD INC	5/4/2005	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	443 S SOTO ST	STE 100	LOS ANGELES	CA	90033	4315	19	06037	34.03962728	-118.2124322	Los Angeles County
89172	Fee-for-Service	1811072978	1811072978	1	1	JEGAPRAGASAN, VANNITHAMB	8/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54047	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
89190	Fee-for-Service	1649885765	1649885765	1	1	JOHNSON MEDICAL CLINIC INC	4/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2090 S EUCLID ST	SUITE 104	ANAHEIM	CA	92802	0000	30	06059	33.79616455	-117.9412293	Orange County
89256	Fee-for-Service	1861570665	1861570665	1	1	JORDAN, JOSEPH P MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79485	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
89271	Fee-for-Service	1275021545	1275021545	1	1	JOHNSON-BLACK, PHOEBE H MD	4/19/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	163477	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
89330	Fee-for-Service	1568655785	1568655785	1	1	JAIME, CINDY M MD	9/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92924	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
89331	Fee-for-Service	1073046934	1073046934	1	1	JAEEL, POOJA A MD	6/23/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158017	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
89375	Fee-for-Service	1043241532	1043241532	1	1	JOHNSON, GHARETT W DC	10/31/2005	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	JOHNSON FAMILY CHIRO	2204 PATTERSON RD	None	RIVERBANK	CA	95367	9647	50	06099	37.73262247	-120.9580515	Stanislaus County
89425	Fee-for-Service	1013099936	1013099936	1	1	JAGAN N BANSAL MD INC	5/4/2005	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	443 S SOTO ST	STE 100	LOS ANGELES	CA	90033	4315	19	06037	34.03962728	-118.2124322	Los Angeles County
89428	Fee-for-Service	1154500965	1154500965	1	2	JA.CORP	11/15/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON	791 EAST ST	None	WOODLAND	CA	95776	4144	57	06113	38.67057432	-121.7655262	Yolo County
89436	Fee-for-Service	1164421798	1164421798	1	1	JASON KIRKHAM 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	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
89437	Fee-for-Service	1700857703	1700857703	1	1	JAMES, VERONIQUE M MD	9/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50068	40	Pediatrics	0	In state provider	None	7300 GIRARD AVE	STE 106	LA JOLLA	CA	92037	5138	37	06073	32.83772948	-117.2716382	San Diego County
89458	Fee-for-Service	1811072978	1811072978	1	1	JEGAPRAGASAN, VANNITHAMB	8/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54047	02	General Surgery	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
89475	Fee-for-Service	1427053891	1427053891	1	1	JENSEN,EDWARD 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	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
89481	Fee-for-Service	1407939614	1407939614	1	1	JACOB, SARAH S MD	8/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	76561	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
89490	Fee-for-Service	1174120349	1174120349	1	2	J & M LAUREL MEDICAL CENTER	4/28/2022	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	13680 VAN NUYS BLVD	None	PACOIMA	CA	91331	3616	19	06037	34.25957089	-118.4310033	Los Angeles County
89521	Fee-for-Service	1437124997	1437124997	1	1	JUAN CARLOS PUYANA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	None	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
89551	Fee-for-Service	1528152717	1528152717	1	1	JOHNSON, CHARLES R MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	32053	41	Internal Medicine	0	In state provider	INC	2400E 8TH ST	SUITE A	NATIONAL CITY	CA	92175	5160	37	06073	32.6827769	-117.0820394	San Diego County
89585	Fee-for-Service	1619088952	1619088952	1	1	JOYNER, ADRIANA M LMFT	5/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2377 GOLD MEADOW WAY	STE 100	GOLD RIVER	CA	95674	4405	34	06067	38.622231	-121.2607575	Sacramento County
89638	Fee-for-Service	1346791423	1346791423	1	1	JANOWSKI, JOSEPH LMFT	1/16/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1137 2ND ST	207	SANTA MONICA	CA	90403	5082	19	06037	34.01807978	-118.5007837	Los Angeles County
89650	Fee-for-Service	1023114733	1023114733	1	1	JONES, CARRI A MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89284	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
89715	Fee-for-Service	1013099936	1013099936	1	1	JAGAN N BANSAL MD INC	5/4/2005	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	443 S SOTO ST	STE 100	LOS ANGELES	CA	90033	4315	19	06037	34.03962728	-118.2124322	Los Angeles County
89722	Fee-for-Service	1124451323	1124451323	1	1	JONAN, ADRIAN B MD	11/14/2018	207L00000X	NA	Other	026	PHYSICIANS	152728	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
89797	Fee-for-Service	1235759580	1235759580	1	1	JOSEFINA DABU DURAN	2/2/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	19213 NESTOR AVE	None	CARSON	CA	90746	2605	19	06037	33.85622985	-118.2446005	Los Angeles County
89857	Fee-for-Service	1477593721	1477593721	1	1	JENSEN, HEATHER S PHD	10/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5855 E NAPLES PLAZA	SUITE 309	LONG BEACH	CA	90803	5091	19	06037	33.75591002	-118.119711	Los Angeles County
89972	Fee-for-Service	1013948694	1013948694	1	1	JEREMY CLIFTON CUZZOURT MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	206 BABB DR	APT A	LEBANON	TN	37087	2686	00	None	36.2214534	-86.3256245	Wilson County
90011	Fee-for-Service	1972662534	1972662534	1	1	JAIME, GUSTAVO M MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84084	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
90064	Fee-for-Service	1750369336	1750369336	1	1	JAIN, KIRAN A MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44854	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
90102	Fee-for-Service	1114193802	1114193802	1	1	JAMES, SIDNEY L DO	11/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10172	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
90218	Fee-for-Service	1821278797	1821278797	1	2	JUNGSTEN, MECHELLE D LMFT	2/28/2024	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
90253	Fee-for-Service	1538272745	1538272745	1	1	JENS F BIRKHOLM DPM INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	821 E CHAPEL ST	STE 101	SANTA MARIA	CA	93454	4618	42	06083	34.95428347	-120.4236585	Santa Barbara County
90406	Fee-for-Service	1932754603	1932754603	1	1	JIMENEZ, KATRINA M LMFT	5/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
90407	Fee-for-Service	1093957037	1093957037	1	1	JOSEPH HUNT, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
90441	Fee-for-Service	1467453498	1467453498	1	1	JONES, TIMOTHY DO	11/6/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	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
90500	Fee-for-Service	1760808240	1760808240	1	1	JUN, JAYSON C CNP	6/15/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
90534	Fee-for-Service	1407874746	1407874746	1	1	JUNG, SYUNG M MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89099	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
90802	Fee-for-Service	1316006299	1316006299	1	1	JOHNSON, HELEN V MD	12/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	82139	None	None	0	In state provider	None	987 PARALLEL DR	STE 104	LAKEPORT	CA	95453	5702	17	06033	39.03584298	-122.9266647	Lake County
90803	Fee-for-Service	1194862771	1194862771	1	1	JESTER, ROBERT W.	1/26/1992	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	532 E FLORIDA AVE	None	HEMET	CA	92543	4334	33	06065	33.7476183	-116.9665293	Riverside County
90821	Fee-for-Service	1821159609	1821159609	1	1	JENKINS, GARY J PHD	2/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
90893	Fee-for-Service	1962962795	1962962795	1	1	JAN, BONNIE MD	4/19/2022	390200000X	NA	Other	026	PHYSICIANS	176345	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
91099	Fee-for-Service	1215389465	1215389465	1	1	JAHAN, FARHANA	5/2/2024	390200000X	NA	Other	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
91184	Fee-for-Service	1235291881	1235291881	1	1	JAVITZ, DAVID O MD	1/1/1994	207R00000X	NA	Other	026	PHYSICIANS	42639	01	General Practice	0	In state provider	None	1941 JOHNSON AVE	STE 303	SAN LUIS OBISPO	CA	93401	4176	40	06079	35.27804785	-120.649711	San Luis Obispo County
91228	Fee-for-Service	1912045931	1912045931	1	1	JAYESH C KAMDAR 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 RIVERSIDE BLVD	APT 14N	NEW YORK	NY	10069	0420	00	None	40.775814	-73.989747	New York County
91231	Fee-for-Service	1659465607	1659465607	1	1	JACOBSON, JULIENNE R MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68305	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
91391	Fee-for-Service	1780098590	1780098590	1	1	JAEN, PRISCELLA LCSW	12/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
91412	Fee-for-Service	1043249642	1043249642	1	1	JOHNSON, ERIC L MD	1/31/1989	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41804	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	375 34TH ST	FL N	OAKLAND	CA	94609	2814	01	06001	37.8221386	-122.2625188	Alameda County
91516	Fee-for-Service	1902244007	1902244007	1	1	JENKINS-PRATT, CARLA V LPCC	8/7/2023	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
91519	Fee-for-Service	1659465607	1659465607	1	1	JACOBSON, JULIENNE R MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68305	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91591	Fee-for-Service	1033128251	1033128251	1	1	JAYANTHI GANESAN, 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
91615	Fee-for-Service	1386630499	1386630499	1	1	JOHN HARRISON,DO	1/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1407 N WHISENANT DR	None	DUNCAN	OK	73533	1650	00	None	34.52038727	-97.97500252	Stephens County
91624	Fee-for-Service	1093008237	1093008237	1	1	JORDAN GLENN	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2320 N 3RD ST	None	PHOENIX	AZ	85004	1303	00	None	33.473745	-112.0697325	Maricopa County
91755	Fee-for-Service	1609549161	1609549161	1	1	JENNINGS, AMY E LCSW	4/6/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
91771	Fee-for-Service	1043398720	1043398720	1	1	JU, EMMALINE N MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73684	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
91774	Fee-for-Service	1356801088	1356801088	1	1	JOH, DANIEL K MD	9/2/2022	208M00000X	NA	Other	026	PHYSICIANS	176190	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
91776	Fee-for-Service	1285801787	1285801787	1	1	JUNAID, IMRAN MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103029	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
91779	Fee-for-Service	1275094666	1275094666	1	1	JACOB, ANJALI MD	6/21/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	182543	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
91904	Fee-for-Service	1649689464	1649689464	1	1	JEN, TIFFANY MD	6/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133773	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
91943	Fee-for-Service	1902192883	1902192883	1	1	JEREMY, JOANNA LMFT	5/16/2020	101YM0800X	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
92064	Fee-for-Service	1235217878	1235217878	1	1	JACKSON, HELEN E MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68577	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
92118	Fee-for-Service	1659379824	1659379824	1	1	JAY H CHAPPELL M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
92129	Fee-for-Service	1518063288	1518063288	1	1	JOSE L LOERA	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3810 PLAZA WAY	None	KENNEWICK	WA	99338	0000	00	None	46.17644625	-119.1911845	Benton County
92176	Fee-for-Service	1841776432	1841776432	1	1	JORDAN, JOSEPH G MD	8/2/2022	207R00000X	NA	Other	026	PHYSICIANS	156632	None	None	0	In state provider	None	12566 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	2006	43	06085	33.78049752	-118.0307808	Orange County
92206	Fee-for-Service	1891787628	1891787628	1	1	JOYCE R DRAYTON	10/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	285 BOULEVARD NE	STE 115	ATLANTA	GA	30312	4207	00	None	33.76248129	-84.37194702	Fulton County
92250	Fee-for-Service	1366579641	1366579641	2	1	JAN & GAILS CARE HOMES INC.	9/29/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3250 W LOYOLA AVE	None	VISALIA	CA	93277	5021	54	06107	36.295776	-119.3273865	Tulare County
92278	Fee-for-Service	1801893961	1801893961	1	1	JONES, CHRISTOPHER U MD	5/31/1991	2085R0001X	NA	Other	026	PHYSICIANS	71383	30	Radiology	0	In state provider	None	5201 F ST	None	SACRAMENTO	CA	95819	3225	34	06067	38.570787	-121.4393895	Sacramento County
92286	Fee-for-Service	1477011427	1477011427	1	1	JIHANI, MANDI	6/3/2019	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
92326	Fee-for-Service	1598965170	1598965170	1	1	JAEGER, GRETCHEN M	4/7/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
92371	Fee-for-Service	1518082023	1518082023	1	1	JACOBSON, AVRAM A MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	8552	22	Pathology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
92439	Fee-for-Service	1083898217	1083898217	1	1	JOO, YOONMEE NP	1/14/2021	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
92454	Fee-for-Service	1063443331	1063443331	1	1	JOHNSON, CHELSEA D MD	12/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172583	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
92457	Fee-for-Service	1154732303	1154732303	2	1	JENNY YU, DPM, INC.	1/15/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13690 E 14TH ST	SUITE 220	SAN LEANDRO	CA	94578	2582	01	06001	37.71615361	-122.1438999	Alameda County
92545	Fee-for-Service	1154583219	1154583219	1	1	JASMINE BADILLO & TERESITA	11/21/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	101 HAWKESBURY WAY	None	VALLEJO	CA	94591	4337	48	06095	38.11706148	-122.2017667	Solano County
92590	Fee-for-Service	1942656319	1942656319	1	1	JOY, KELLY C MD	9/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153056	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
92639	Fee-for-Service	1215390828	1215390828	1	1	JAMISON, EMMA L MD	8/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168840	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
92659	Fee-for-Service	1265753172	1265753172	1	1	JENNIFER LEIGH GREER, FNP	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	405 MARKET ST	None	PORT GIBSON	MS	39150	2024	00	None	31.96292749	-90.98336871	Claiborne County
92761	Fee-for-Service	1831370741	1831370741	1	1	JEFFREY SCOTT GITT, 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	3815 E BELL RD	STE 2400	PHOENIX	AZ	85032	2145	00	None	33.638571	-111.9990015	Maricopa County
92837	Fee-for-Service	1639258650	1639258650	1	1	JURATSCH, CRAIG E MD	7/31/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64550	01	General Practice	0	In state provider	None	310 S HALCYON RD	STE 106	ARROYO GRANDE	CA	93420	3863	40	06079	35.11464177	-120.5916364	San Luis Obispo County
92844	Fee-for-Service	1316942261	1316942261	1	1	JIBILIAN, ARTIN Y MD INC	8/24/2004	208800000X	NA	Other	026	PHYSICIANS	29331	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
92910	Fee-for-Service	1205025996	1205025996	1	1	JUMAGDAO-SAKAI, MARIA D	4/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96657	08	Family Practice	0	In state provider	MD	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
92911	Fee-for-Service	1730205220	1730205220	1	1	JULIAN, KATIE M MD	12/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119083	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
92953	Fee-for-Service	1992965156	1992965156	1	1	JAIN, VIKAS MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115489	08	Family Practice	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93015	Fee-for-Service	1639602279	1639602279	1	1	JAYARAM, LAKSHMI A MD	10/30/2023	207RR0500X	NA	Other	026	PHYSICIANS	191535	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93017	Fee-for-Service	1831612100	1831612100	1	1	JEN, MARIA C OD	1/7/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
93020	Fee-for-Service	1023464609	1023464609	1	1	JORDAN SMITH DO	11/4/2023	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
93043	Fee-for-Service	1487857348	1487857348	1	1	JIBRIL, AHMED K PSYD	8/10/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1216 34TH ST	None	OAKLAND	CA	94610	2816	01	06001	37.80308138	-122.2341623	Alameda County
93047	Fee-for-Service	1114072337	1114072337	1	1	JULIUS A CRUZ MD INC	9/17/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26021	02	General Surgery	0	In state provider	None	15203 11TH ST	STE C	VICTORVILLE	CA	92395	3737	36	06071	34.52758919	-117.2925085	San Bernardino County
93055	Fee-for-Service	1023551488	1023551488	1	1	JOHNSON, DEBRA F LCSW	9/13/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
93140	Fee-for-Service	1821475393	1821475393	1	1	JUTZY, JESSICA M MD	8/3/2020	2085R0001X	NA	Other	026	PHYSICIANS	168994	32	Radiation Therapy (D.O. 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
93191	Fee-for-Service	1457791683	1457791683	1	1	JAIN, VANDANA MD	4/16/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	138629	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
93204	Fee-for-Service	1356747687	1356747687	1	1	JACOBS, MICHELLE L NP	2/8/2024	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
93211	Fee-for-Service	1275271405	1275271405	1	1	JORDEN, TRISTAN J	9/1/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5062 HARVARD AVE	None	WESTMINSTER	CA	92683	2701	30	06059	33.7612065	-118.0414575	Orange County
93250	Fee-for-Service	1487245866	1487245866	1	1	JOHNSON, JASMINE M LMFT	5/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
93264	Fee-for-Service	1780242495	1780242495	1	1	JOY ACUPUNCTURE HEALING ARTS	8/21/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	4420 HOTEL CIRCLE CT	265	SAN DIEGO	CA	92108	3434	37	06073	32.75818782	-117.1746702	San Diego County
93271	Fee-for-Service	1891735445	1891735445	1	1	JACKA, CIARAN P DPM	2/8/2015	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2089 VALE RD	STE 32	SAN PABLO	CA	94806	3850	07	06013	37.95396781	-122.3375393	Contra Costa County
93272	Fee-for-Service	1790738292	1790738292	1	1	JIN, ALBERT S MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64592	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
93284	Fee-for-Service	1275095812	1275095812	1	1	JOSHI, SAKSHI MD	11/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178930	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
93288	Fee-for-Service	1609040427	1609040427	1	1	JOANNE RUTH MONTGOMERY M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4656 40TH AVE S	STE 130	FARGO	ND	58104	4397	00	None	46.817748	-96.865461	Cass County
93293	Fee-for-Service	1487418232	1487418232	1	1	JAMES, KYLEE CPD	2/27/2024	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
93322	Fee-for-Service	1184159337	1184159337	1	1	JOURABCHI, AMIR M	2/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20195	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
93335	Fee-for-Service	1114072337	1114072337	1	1	JULIUS A CRUZ MD INC	9/17/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26021	01	General Practice	0	In state provider	None	15203 11TH ST	STE C	VICTORVILLE	CA	92395	3737	36	06071	34.52758919	-117.2925085	San Bernardino County
93391	Fee-for-Service	1285850974	1285850974	1	1	JACKSON, ELENA B MD	12/26/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97558	40	Pediatrics	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
93408	Fee-for-Service	1659371425	1659371425	1	1	JODI K NOVAK, 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	10229 N 92ND ST	STE I-103	SCOTTSDALE	AZ	85258	0000	00	None	33.579099	-111.878703	Maricopa County
93427	Fee-for-Service	1821475393	1821475393	1	1	JUTZY, JESSICA M MD	8/3/2020	2085R0001X	NA	Other	026	PHYSICIANS	168994	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
93456	Fee-for-Service	1750662854	1750662854	1	1	JAKOBSON, HARRY C LCSW	5/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1428 DARTWOOD DR	None	CHICO	CA	95926	7150	04	06007	39.73291986	-121.8691209	Butte County
93471	Fee-for-Service	1538611280	1538611280	1	1	JOHNSON, SHAY PT	3/4/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2835 CHILDRESS DR	None	ANDERSON	CA	96007	3563	45	06089	40.45498247	-122.2907255	Shasta County
93485	Fee-for-Service	1306924089	1306924089	1	1	JOHL, SUKHJIT S MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61512	18	Ophthalmology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
93501	Fee-for-Service	1275271405	1275271405	1	1	JORDEN, TRISTAN J	9/1/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5062 HARVARD AVE	None	WESTMINSTER	CA	92683	2701	30	06059	33.7612065	-118.0414575	Orange County
93506	Fee-for-Service	1255758314	1255758314	1	2	JARKA, CHRISTINE R LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6571 BUTTERFIELD WAY	None	PLACERVILLE	CA	95667	8796	09	06017	38.73841246	-120.8919063	El Dorado County
93512	Fee-for-Service	1326061185	1326061185	1	1	JONATHAN P HALE MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 S 900 E	None	SALT LAKE CTY	UT	84105	3208	00	None	40.72717962	-111.8653749	Salt Lake County
93555	Fee-for-Service	1396882650	1396882650	1	1	JEFREY SIROTA	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
93581	Fee-for-Service	1467715672	1467715672	1	1	JAVANFARD, ELAN LMFT	5/6/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87054	-	NOT APPLICABLE	0	In state provider	None	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	19	06037	34.00134941	-118.4039837	Los Angeles County
93583	Fee-for-Service	1841989068	1841989068	1	1	JEAN, ALISA	5/3/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
93603	Fee-for-Service	1972134047	1972134047	1	1	JOSE, PRINCE M	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	1818 ASHFORD COURT	None	FAIRFIELD	CA	94533	8997	48	06095	38.29545432	-122.0143014	Solano County
93668	Fee-for-Service	1811992928	1811992928	1	1	JANET K HARNSBERGER M.D.	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
93735	Fee-for-Service	1043368913	1043368913	1	1	JAHAN-PARWAR, SASAN MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76407	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
93744	Fee-for-Service	1740274380	1740274380	1	1	JOHNSON, NEIL G MD INC	4/30/1996	207T00000X	NA	General Surgery	026	PHYSICIANS	20232	14	Neurological Surgery	0	In state provider	None	401 E HIGHLAND AVE	STE 553	SAN BERNARDINO	CA	92404	3839	36	06071	34.1358627	-117.2757778	San Bernardino County
93795	Fee-for-Service	1306336623	1306336623	1	1	JAVIER, FRANCES G MD	3/30/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183410	36	Psychiatry	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
93859	Fee-for-Service	1972573756	1972573756	1	1	JORDON, AARON S	12/31/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	48703	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
93875	Fee-for-Service	1801217435	1801217435	1	1	J L AND J INC	3/21/2018	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	3630 E IMPERIAL HIGHWAY	SUITE 204	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
93877	Fee-for-Service	1659696979	1659696979	1	1	JACOBS, PAUL E DO	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13892	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
93890	Fee-for-Service	1891986048	1891986048	1	1	JALIL, NASREEN MD	1/21/2025	208M00000X	NA	Other	026	PHYSICIANS	147614	41	Internal Medicine	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
93892	Fee-for-Service	1972134047	1972134047	1	1	JOSE, PRINCE M	2/14/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1818 ASHFORD COURT	None	FAIRFIELD	CA	94533	8997	48	06095	38.29545432	-122.0143014	Solano County
93917	Fee-for-Service	1922420199	1922420199	1	1	JUNG, CARRIE E MD	8/28/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	128321	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
93933	Fee-for-Service	1285130559	1285130559	1	1	JONES, TYLER S MD	6/2/2022	207L00000X	NA	Other	026	PHYSICIANS	175676	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
93962	Fee-for-Service	1073600359	1073600359	1	1	JONES, SHARON Y MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82283	26	Psychiatry (child)	0	In state provider	None	4010 WATSON PLAZA DR	STE 170	LAKEWOOD	CA	90712	4000	19	06037	33.83123565	-118.1550195	Los Angeles County
94212	Fee-for-Service	1578641213	1578641213	1	1	JANG, CHRISTINE M MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70539	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
94249	Fee-for-Service	1073600359	1073600359	1	1	JONES, SHARON Y MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82283	36	Psychiatry	0	In state provider	None	4010 WATSON PLAZA DR	STE 170	LAKEWOOD	CA	90712	4000	19	06037	33.83123565	-118.1550195	Los Angeles County
94287	Fee-for-Service	1942225057	1942225057	1	1	JAMIESON, MARK A MD	5/1/1999	207L00000X	NA	Other	026	PHYSICIANS	61068	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
94377	Fee-for-Service	1558324582	1558324582	1	1	JAIN, KIREN S MD	9/30/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88160	None	None	0	In state provider	None	3031 TISCH WAY	STE 400	SAN JOSE	CA	95128	2541	43	06085	37.3171883	-121.947648	Santa Clara County
94414	Fee-for-Service	1780110338	1780110338	1	1	JOO, WOOJIN MD	1/19/2021	207R00000X	NA	Other	026	PHYSICIANS	160312	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
94435	Fee-for-Service	1013044601	1013044601	1	1	JAUREGUITO, JOHN W MD	5/22/2001	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	81317	20	Orthopedic Surgery	0	In state provider	None	3555 BEACON AVE	None	FREMONT	CA	94538	1407	01	06001	37.54931973	-121.9815069	Alameda County
94563	Fee-for-Service	1831652254	1831652254	1	1	JORGENSEN, JENNA C MD	9/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176988	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
94577	Fee-for-Service	1548584535	1548584535	1	1	JACKSON, JENNIFER L LCSW	1/31/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
94639	Fee-for-Service	1518438183	1518438183	1	1	JEWEL HOMECARE	12/20/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5111 HAMER LANE	None	PLACENTIA	CA	92870	3665	30	06059	33.88765642	-117.8497097	Orange County
94678	Fee-for-Service	1356898357	1356898357	1	1	JAGA MEDICAL GROUP INC	10/12/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1400 COLORADO BLVD	A	EAGLE ROCK	CA	90041	2321	19	06037	34.13938724	-118.1947058	Los Angeles County
94729	Fee-for-Service	1205192911	1205192911	1	1	JILL M ZABIH	7/23/2018	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
94755	Fee-for-Service	1265827794	1265827794	1	1	JAMES, MATTHEW K MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	161621	None	None	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
94795	Fee-for-Service	1639490824	1639490824	1	1	JOSHI, NIRAV D MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92059	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
94862	Fee-for-Service	1063729630	1063729630	1	1	JAVED, NAJWA M DPM	10/3/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
94918	Fee-for-Service	1639691579	1639691579	1	1	JANG, JEE HOON MD	9/25/2024	207R00000X	NA	Other	026	PHYSICIANS	173800	41	Internal Medicine	0	In state provider	None	3545 WILSHIRE BLVD	STE 202	LOS ANGELES	CA	90010	2378	19	06037	34.0617575	-118.301985	Los Angeles County
95030	Fee-for-Service	1982890885	1982890885	1	1	JOHNSON, RYAN C DO	6/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11729	15	Obstetrics (D.O. only)	0	In state provider	None	2505 E. DIVISADERO ST	None	FRESNO	CA	93721	1401	10	06019	36.74334929	-119.7809344	Fresno County
95069	Fee-for-Service	1821660986	1821660986	1	1	JACKSON, JASMINE LMFT	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
95254	Fee-for-Service	1396867867	1396867867	1	1	JOHNSON, ALEXANDRA A LCSW	9/1/2010	1041C0700X	NA	Mental Health Outpatient Services	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	640 W 20TH ST	None	SAN PEDRO	CA	90731	5520	19	06037	33.72607349	-118.2911715	Los Angeles County
95322	Fee-for-Service	1982890885	1982890885	1	1	JOHNSON, RYAN C DO	6/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11729	09	Gynecology (D.O. only)	0	In state provider	None	2505 E. DIVISADERO ST	None	FRESNO	CA	93721	1401	10	06019	36.74334929	-119.7809344	Fresno County
95329	Fee-for-Service	1417282583	1417282583	1	1	JASON KEENE	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
95422	Fee-for-Service	1902654536	1902654536	1	1	JORGE R. LOPEZ MD A PROFESSI	5/30/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	01	General Practice	0	In state provider	ONAL MEDICAL CORPORATION	2740 S. BRISTOL ST.,	SUITE 100	SANTA ANA	CA	92704	6232	30	06059	33.70999696	-117.8854626	Orange County
95512	Fee-for-Service	1023285244	1023285244	1	1	JINDAL, VIKAS MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128173	01	General Practice	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
95541	Fee-for-Service	1679700181	1679700181	1	1	JAMALL, AKBAR A MD	5/1/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	111145	None	None	0	In state provider	None	39263 MISSION BLVD	None	FREMONT	CA	94539	3037	01	06001	37.56282031	-121.9592214	Alameda County
95567	Fee-for-Service	1972788651	1972788651	1	1	JAGAN, LISAANN LCSW	11/27/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	765 N MAIN ST	146	CORONA	CA	92878	1440	33	06065	33.8919027	-117.5637532	Riverside County
95591	Fee-for-Service	1346218047	1346218047	1	1	JUNEJO, NAZIA MD	4/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129823	41	Internal Medicine	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
95670	Fee-for-Service	1164032082	1164032082	1	1	JONES, JEREMIAH LCSW	5/8/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	129940	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
95787	Fee-for-Service	1770653693	1770653693	1	1	JANG, HARRY K MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45445	41	Internal Medicine	0	In state provider	None	950 CASS ST	STE A	MONTEREY	CA	93940	4547	27	06053	36.59271384	-121.8962446	Monterey County
95821	Fee-for-Service	1477141265	1477141265	1	1	JOU, NANCY NP	11/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3628 EAST IMPERIAL HWY	202	LYNWOOD	CA	90262	2600	19	06037	33.93070837	-118.2044557	Los Angeles County
95823	Fee-for-Service	1588641385	1588641385	1	1	JURRENS, TRACI LYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 N 30TH ST	None	OMAHA	NE	68131	2137	00	None	41.2654263	-95.95644327	Douglas County
95951	Fee-for-Service	1447221544	1447221544	1	1	JATIN SHAH MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14873 W BELL RD	STE 100	SURPRISE	AZ	85374	7609	00	None	33.637221	-112.3806285	Maricopa County
95984	Fee-for-Service	1508187063	1508187063	1	1	JUNG, YEWAH DO	4/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13987	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
96008	Fee-for-Service	1124241302	1124241302	1	1	JOYCE, NANETTE C DO	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10309	25	Physical Medicine and Rehabilitation	0	In state provider	ACCTS RECEIVABLE	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
96075	Fee-for-Service	1659717882	1659717882	1	1	JAIN, RUCHI DO	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15911	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
96099	Fee-for-Service	1629159876	1629159876	1	1	JAMIL, TARIQ	12/26/2007	174400000X	NA	Other	026	PHYSICIANS	70628	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 502	SAN BERNARDINO	CA	92404	3809	36	06071	34.1358627	-117.2757898	San Bernardino County
96142	Fee-for-Service	1457392748	1457392748	1	1	JOHN Q KNOCHEL M.D.	11/14/2013	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
96215	Fee-for-Service	1043416480	1043416480	1	1	JORDAN, VERONICA A MD	2/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105065	08	Family Practice	0	In state provider	None	3883 AIRWAY DR	#202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
96225	Fee-for-Service	1508875642	1508875642	1	1	JIBODH, STEFAN R MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104528	20	Orthopedic Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
96236	Fee-for-Service	1669148391	1669148391	1	1	JACKS, CODY J PT	12/3/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2835 CHILDRESS DR	None	ANDERSON	CA	96007	3563	45	06089	40.45498247	-122.2907255	Shasta County
96244	Fee-for-Service	1669673505	1669673505	1	1	JOHNSON, RALPH S MD	12/26/2007	207R00000X	NA	Other	026	PHYSICIANS	100739	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
96297	Fee-for-Service	1124241302	1124241302	1	1	JOYCE, NANETTE C DO	8/1/2014	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	ACCTS RECEIVABLE	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
96319	Fee-for-Service	1871577312	1871577312	1	1	JHATAKIA, SEJAL A MD	12/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
96440	Fee-for-Service	1134193808	1134193808	1	1	JAMES MICHAEL MOUNTZ MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 395O	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
96480	Fee-for-Service	1073691705	1073691705	1	1	JOHN, BIJU MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79801	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
96491	Fee-for-Service	1003027376	1003027376	1	1	JUNCK, ANTHONY D MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121237	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
96538	Fee-for-Service	1619067253	1619067253	1	1	JULIE C LEONARD MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
96584	Fee-for-Service	1013073485	1013073485	1	1	JOHNSON, ROGER PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
96634	Fee-for-Service	1598024226	1598024226	1	1	JAIN, SHVETA MD	7/1/2017	390200000X	NA	Other	026	PHYSICIANS	126443	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
96695	Fee-for-Service	1598170334	1598170334	1	1	JACKSON, NORALYN M	10/24/2024	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
96731	Fee-for-Service	1891924957	1891924957	1	1	JAKKULA, JAGAN MOHAN RAO MD	7/16/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153085	36	Psychiatry	0	In state provider	None	24432 MUIRLANDS BLVD	SUTIE 131	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
96763	Fee-for-Service	1700854007	1700854007	1	1	JUAREZ, DOUGLAS MD	6/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51964	22	Pathology (M.D. only)	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
96855	Fee-for-Service	1205981982	1205981982	1	1	JONES, BRENDA E MD	6/13/2012	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	52604	77	Infectious Disease	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
96899	Fee-for-Service	1912162371	1912162371	1	1	JOHNSON, ERIC MD	9/10/2008	207L00000X	NA	Other	026	PHYSICIANS	10379	05	Anesthesiology	0	In state provider	None	3315 WATT AVENUE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
96952	Fee-for-Service	1053601872	1053601872	1	1	JONES, LACENA L LMFT	11/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	325	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
96980	Fee-for-Service	1902040207	1902040207	1	1	JOHAR, AMARDEEP S MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141116	30	Radiology	0	In state provider	None	99 MONTICELLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
97033	Fee-for-Service	1356967863	1356967863	1	1	JOHNSON, MATTHEW C MD	7/24/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 2505	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
97046	Fee-for-Service	1679971063	1679971063	1	1	JAMESON, ROBERT L OT	12/2/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
97057	Fee-for-Service	1225070139	1225070139	1	1	JUE, KATHERINE F MD	11/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91660	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
97090	Fee-for-Service	1013128222	1013128222	1	1	JAMES DANIEL DEWAR D.O.	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
97207	Fee-for-Service	1235112160	1235112160	1	1	JORNLIN, WILLIAM A MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64104	08	Family Practice	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
97231	Fee-for-Service	1295092740	1295092740	1	1	JONAS, STEVEN J MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128070	78	Neoplastic Diseases/Oncology	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
97236	Fee-for-Service	1841500527	1841500527	1	1	JIANG, KEYI MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141768	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
97290	Fee-for-Service	1538220884	1538220884	1	1	JACKSON, CHRISTINE D	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
97408	Fee-for-Service	1376592733	1376592733	1	1	JACOBSON, GRETCHEN H MD	11/6/2010	207T00000X	NA	General Surgery	026	PHYSICIANS	63450	14	Neurological Surgery	0	In state provider	None	1700 N ROSE AVE	STE 220	OXNARD	CA	93030	7640	56	06111	34.21746	-119.155545	Ventura County
97518	Fee-for-Service	1295092740	1295092740	1	1	JONAS, STEVEN J MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128070	66	Emergency Medicine (Urgent Care)	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
97544	Fee-for-Service	1770112286	1770112286	1	1	JAFFREY, CARSON S LCSW	10/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97661	Fee-for-Service	1558034637	1558034637	1	1	JUAT, MICHELLE NP	4/15/2022	163W00000X	NA	Other	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
97694	Fee-for-Service	1780994426	1780994426	1	1	JARADAT, AHMED A MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
97697	Fee-for-Service	1942404769	1942404769	1	1	JAMES, DIANNA BERNICE MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125990	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
97769	Fee-for-Service	1881601813	1881601813	1	1	JO, ANGELA M MD	7/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76859	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
97783	Fee-for-Service	1427839786	1427839786	1	1	JANSSEN, BRINA	1/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
97794	Fee-for-Service	1518992668	1518992668	1	1	JOST, PETER F MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81661	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
97807	Fee-for-Service	1295092740	1295092740	1	1	JONAS, STEVEN J MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128070	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
97830	Fee-for-Service	1669432167	1669432167	1	1	JORDAN, STANLEY C MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	26161	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
97886	Fee-for-Service	1982304531	1982304531	1	1	JUDITH A. VERDUZCO, LICENSED	5/25/2023	193200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3156 FOOTHILL BLVD	SUITE C	LA CRESCENTA	CA	91214	4261	19	06037	34.22918771	-118.2480953	Los Angeles County
97916	Fee-for-Service	1922114776	1922114776	1	1	JAMES D MCCHESNEY MD	1/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
97984	Fee-for-Service	1942404769	1942404769	1	1	JAMES, DIANNA BERNICE MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125990	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
98040	Fee-for-Service	1497997050	1497997050	2	1	JEAN-BAPTISTE, RYAN S MD	12/6/2022	2085R0204X	NA	Other	026	PHYSICIANS	182986	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
98080	Fee-for-Service	1720090301	1720090301	1	1	JEROME, DENNIS C MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34461	03	Allergy	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
98118	Fee-for-Service	1669432167	1669432167	1	1	JORDAN, STANLEY C MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	26161	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
98120	Fee-for-Service	1184390296	1184390296	1	1	JACKSON, MAURICE D OD	4/26/2022	152W00000X	NA	Other	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
98147	Fee-for-Service	1669211272	1669211272	1	1	JORDAN CROSSING MINISTRIES	5/22/2024	324500000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	1566 HUNTOON ST	None	OROVILLE	CA	95965	4922	04	06007	39.51137474	-121.5553799	Butte County
98163	Fee-for-Service	1306139035	1306139035	1	1	JILANI, SHAIQUEL A MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132105	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
98275	Fee-for-Service	1245783075	1245783075	1	1	JAIN, SAMHITA	7/6/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	160576	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
98387	Fee-for-Service	1366732398	1366732398	1	1	JOY WORTHAM, M.D.	7/18/2015	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	2719	00	None	35.08771808	-106.6192188	Bernalillo County
98402	Fee-for-Service	1851962534	1851962534	1	1	JILLYN SORIANO OD OPTOMETRIC	8/30/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2370 CRENSHAW BLVD	SUITE O	TORRANCE	CA	90501	3352	19	06037	33.82340482	-118.3284822	Los Angeles County
98403	Fee-for-Service	1093119364	1093119364	1	1	JEZIOR, KRISTEN L PHD	2/10/2020	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
98411	Fee-for-Service	1497819825	1497819825	1	1	JONES, JANELLA S	11/7/2016	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
98463	Fee-for-Service	1437577731	1437577731	1	1	JAKATDAR, AVANTI MD	6/26/2020	207R00000X	NA	Other	026	PHYSICIANS	163417	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
98547	Fee-for-Service	1346448859	1346448859	1	1	JACOBSON, JOEL MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116331	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
98550	Fee-for-Service	1043434012	1043434012	1	1	JOOLHAR, FOWROOZ S MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55067	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	1510 S CENTRAL AVE	STE 650	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
98656	Fee-for-Service	1760138952	1760138952	1	1	JUNGLES, HALEY M CRNA	3/30/2022	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
98673	Fee-for-Service	1356350631	1356350631	1	1	JAMES B. ECKARD, 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	3555 S VAL VISTA DR	None	GILBERT	AZ	85297	7323	00	None	33.286572	-111.7527525	Maricopa County
98678	Fee-for-Service	1013127174	1013127174	1	1	JOSEPH, BELLAL ALI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
98728	Fee-for-Service	1972542652	1972542652	1	1	JAY BROOKS JACKSON	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
98756	Fee-for-Service	1477676096	1477676096	1	1	JACKSON-GARBER, DEVERA LMFT	7/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19652 FOREST AVENUE	None	CASTRO VALLEY	CA	94546	3522	01	06001	37.70228649	-122.0687872	Alameda County
98826	Fee-for-Service	1487005583	1487005583	1	1	JU, CHRISTINE MD	6/11/2020	207P00000X	NA	Other	026	PHYSICIANS	168395	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
98856	Fee-for-Service	1497707699	1497707699	1	1	JULIAN, YOLANDA M DO	9/25/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	6667	-	NOT APPLICABLE	0	In state provider	None	7225 EAST SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2651	34	06067	38.49489	-121.435704	Sacramento County
98872	Fee-for-Service	1841234382	1841234382	1	1	JACOBS, STEVEN S MD	5/1/1983	207L00000X	NA	Other	026	PHYSICIANS	46540	05	Anesthesiology	0	In state provider	STE 302	203 WILLOW ST	None	SAN FRANCISCO	CA	94109	7734	38	06075	37.78326038	-122.4212876	San Francisco County
98924	Fee-for-Service	1912262643	1912262643	1	1	JAGGI, KHUSHLEEN MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147232	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
98974	Fee-for-Service	1093947988	1093947988	1	1	JOSHI, NIKITA K MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124611	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
99028	Fee-for-Service	1215948591	1215948591	1	1	JACQUELINE B ESCH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3213 S 24TH ST	STE 200	OMAHA	NE	68108	1832	00	None	41.228838	-95.94703104	Douglas County
99097	Fee-for-Service	1770683658	1770683658	1	1	JOHNSON, LIBRE E MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76860	01	General Practice	0	In state provider	None	2280 HARRISON AVENUE	STE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
99145	Fee-for-Service	1043402811	1043402811	1	1	JOANNA AGNANT	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
99409	Fee-for-Service	1164539953	1164539953	1	1	JOE, VICTOR C MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61858	02	General Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
99440	Fee-for-Service	1588723159	1588723159	1	1	JONES-GOMBERG, SARA MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54269	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
99478	Fee-for-Service	1417035064	1417035064	1	1	JASIULEK, HARALD U MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42192	02	General Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
99523	Fee-for-Service	1366426306	1366426306	1	1	JAYASEKARA, DEEPTHI K MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69077	41	Internal Medicine	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
99562	Fee-for-Service	1942734348	1942734348	1	1	JOHANSEN, DANIEL	10/23/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161284	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
99657	Fee-for-Service	1528632627	1528632627	1	1	JASON M MOSS, MD, MEDICAL CO	10/5/2021	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	5555 RESERVOIR DR	201	SAN DIEGO	CA	92120	5191	37	06073	32.77628471	-117.0563688	San Diego County
99749	Fee-for-Service	1558604371	1558604371	1	1	JANI, NIRAJ K MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134577	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
99752	Fee-for-Service	1013030667	1013030667	1	1	JOYCE I BANDELE	10/2/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	JOYCE MED EQUIP & SUPPLY	222 E HIGHLAND AVE	SUITE 2	SAN BERNARDINO	CA	92404	3704	36	06071	34.13597079	-117.2815636	San Bernardino County
99769	Fee-for-Service	1467132605	1467132605	1	1	JONATHAN LIANG DO INC	7/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	4320 MARICOPA ST	None	TORRANCE	CA	90503	4314	19	06037	33.83949675	-118.3597243	Los Angeles County
99810	Fee-for-Service	1366426306	1366426306	1	1	JAYASEKARA, DEEPTHI K MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69077	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
99818	Fee-for-Service	1396993291	1396993291	1	1	JOHNSON, BENJAMIN F MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111648	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
100002	Fee-for-Service	1023493244	1023493244	1	1	JMC PHARMACY INC	9/26/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3907 CHICAGO AVE	#A	RIVERSIDE	CA	92507	5367	33	06065	33.974064	-117.348474	Riverside County
100055	Fee-for-Service	1275791881	1275791881	1	1	JAIN, PRIYANKA MD	12/9/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161938	18	Ophthalmology	0	In state provider	None	580 COLLINS DR	None	MERCED	CA	95348	3121	24	06047	37.32266954	-120.4774245	Merced County
100114	Fee-for-Service	1972538155	1972538155	1	1	JOHN M FALGOUT NP	11/23/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1990 INDUSTRIAL BLVD	None	HOUMA	LA	70363	7055	00	None	29.57007888	-90.68782355	Terrebonne Parish
100122	Fee-for-Service	1588855605	1588855605	1	1	JACKSON, ANDREA V MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116955	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
100162	Fee-for-Service	1669799557	1669799557	1	1	JAVIER, EDUARDO P JR MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111036	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100171	Fee-for-Service	1487121422	1487121422	1	1	JCH LTC PHARMACY, LLC	6/23/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1428 33RD ST	None	SACRAMENTO	CA	95816	5322	34	06067	38.568042	-121.4642205	Sacramento County
100238	Fee-for-Service	1851636880	1851636880	1	1	JAEGER, CATHERINE D LMFT	2/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
100367	Fee-for-Service	1821836362	1821836362	1	1	JOSHI, KUNAL A MD	1/3/2025	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
100412	Fee-for-Service	1578556304	1578556304	1	1	JOSEPH ALAN DINKINS, 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	1000 E 100 N	None	PAYSON	UT	84651	1600	00	None	40.04472385	-111.7145663	Utah County
100442	Fee-for-Service	1063598563	1063598563	1	1	JOSHI, SANGEETA T MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69374	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
100546	Fee-for-Service	1760773113	1760773113	1	1	JETER, CHRYSTINA A MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122819	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
100603	Fee-for-Service	1689293870	1689293870	1	1	JENSEN, ERICA	6/14/2023	390200000X	NA	Other	026	PHYSICIANS	184555	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
100659	Fee-for-Service	1427053867	1427053867	1	1	JOHNSON, JARROD D DO	2/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	1299 BERTHA HOWE	None	MESQUITE	NV	89027	7500	00	None	36.80863769	-114.1155175	Clark County
100668	Fee-for-Service	1114319423	1114319423	1	1	JI, JINGRAN MD	5/29/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	163688	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
100728	Fee-for-Service	1124178983	1124178983	2	1	JAN & GAIL'S CARE HOMES INC.	9/29/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	134 N SANTA CLARA ST	None	TULARE	CA	93274	3540	54	06107	36.20704332	-119.3641473	Tulare County
100734	Fee-for-Service	1821424169	1821424169	1	1	JONES, JENNIFER M	4/13/2015	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
100820	Fee-for-Service	1477117208	1477117208	1	1	JHAWAR, AMANDEEP PSYD	1/27/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
100830	Fee-for-Service	1629415088	1629415088	1	1	JONES, NANCY ARLEEN LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13241 OAK DELL ST	None	MORENO VALLEY	CA	92553	7839	33	06065	33.92804435	-117.2618545	Riverside County
100955	Fee-for-Service	1114319423	1114319423	1	1	JI, JINGRAN MD	5/29/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	163688	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
101005	Fee-for-Service	1235257502	1235257502	1	1	JAEGGI, LUKAS PSYD	9/17/2024	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
101093	Fee-for-Service	1669424982	1669424982	1	1	JACKSON, ROY H MD INC	11/1/1994	207R00000X	NA	Other	026	PHYSICIANS	30184	41	Internal Medicine	0	In state provider	None	185 S EUCLID AVE	STE 2	PASADENA	CA	91101	2420	19	06037	34.14233627	-118.1429909	Los Angeles County
101129	Fee-for-Service	1730130576	1730130576	1	1	JARADEH, SAFWAN S MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54540	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
101135	Fee-for-Service	1942868229	1942868229	1	1	JEONG, SUN YOUNG MD	8/1/2022	207R00000X	NA	Other	026	PHYSICIANS	177543	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
101262	Fee-for-Service	1871665935	1871665935	1	1	JOHANSSON, ROBERT A	4/5/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
101313	Fee-for-Service	1558487140	1558487140	1	1	JAGANNATH, MEERA DO	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	8868	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
101321	Fee-for-Service	1689878969	1689878969	1	1	JANOWSKI, MARK C MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86276	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
101353	Fee-for-Service	1336433192	1336433192	2	1	JEANNETTE ZINGGELER BERG	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 W IRONWOOD DR	STE 378	COEUR D ALENE	ID	83814	4401	00	None	47.69438484	-116.7931559	Kootenai County
101476	Fee-for-Service	1891925889	1891925889	1	1	JUNG, TAE W DO	12/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13428	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
101509	Fee-for-Service	1336778398	1336778398	1	1	JIN, TAEGUN DO	4/1/2025	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	22888	25	Physical Medicine and Rehabilitation	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
101539	Fee-for-Service	1528301462	1528301462	1	1	JENSEN, KRISTIN S MD	4/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133931	None	None	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
101578	Fee-for-Service	1356424360	1356424360	1	1	JOLTON, FRANCINE MD	12/17/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73130	40	Pediatrics	0	In state provider	MERRITHEW MEMORIAL HOSP	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
101610	Fee-for-Service	1689878969	1689878969	1	1	JANOWSKI, MARK C MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86276	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
101745	Fee-for-Service	1801151923	1801151923	1	1	JAIN, SHREYA MD	2/8/2016	390200000X	NA	Other	026	PHYSICIANS	136039	None	None	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	6331	54	06107	36.332253	-119.288691	Tulare County
101773	Fee-for-Service	1073685889	1073685889	1	1	JAIN, SONALI K MD	2/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87409	08	Family Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
101794	Fee-for-Service	1992742530	1992742530	1	1	JAMIE RAE SHANDRO 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	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
101799	Fee-for-Service	1699153130	1699153130	1	1	JACKSON, RYAN P MD	4/18/2021	207ZB0001X	NA	Other	026	PHYSICIANS	150177	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
101804	Fee-for-Service	1548266349	1548266349	1	1	JENSEN, DAG 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	2930 SQUALICUM PKWY	STE 101	BELLINGHAM	WA	98225	1854	00	None	48.77232859	-122.4750679	Whatcom County
101856	Fee-for-Service	1205572369	1205572369	1	1	JIH, ANN LMFT	1/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
101867	Fee-for-Service	1154380301	1154380301	1	1	JABOUR, ADEL F MD	9/25/2008	174400000X	NA	Other	026	PHYSICIANS	30429	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4147	19	06037	34.22073847	-118.532988	Los Angeles County
101904	Fee-for-Service	1093001042	1093001042	1	1	JASON VAN VALKENBURG M.D.	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
101963	Fee-for-Service	1710065271	1710065271	1	1	JOYCE M BRACKEBUSCH	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	360 S GARDEN WAY	STE 200	EUGENE	OR	97401	8174	00	None	44.05611538	-123.0539516	Lane County
102043	Fee-for-Service	1548478878	1548478878	1	1	JACKSON, ROSA LCSW	3/8/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
102062	Fee-for-Service	1073685889	1073685889	1	1	JAIN, SONALI K MD	2/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87409	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
102099	Fee-for-Service	1073967469	1073967469	1	1	JAJU, PRAJAKTA D MD	9/11/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	150830	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
102100	Fee-for-Service	1316597693	1316597693	1	1	JOON CHOI MD A PROFESSIONAL	3/1/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
102184	Fee-for-Service	1992358444	1992358444	1	1	JOSEPH HADI MD PC	8/13/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	VE MEDICINE INSTITUTE	5400 BALBOA BLVD	STE 301	ENCINO	CA	91316	1530	19	06037	34.169283	-118.501072	Los Angeles County
102237	Fee-for-Service	1346206190	1346206190	1	1	JABLONS, DAVID M MD	1/31/1993	208G00000X	NA	General Surgery	026	PHYSICIANS	78033	33	Thoracic Surgery	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
102241	Fee-for-Service	1609134584	1609134584	1	1	JACOBO, CRYSTAL LMFT	3/3/2025	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
102244	Fee-for-Service	1184785610	1184785610	1	1	JUINIO, KIRSTEN I	1/30/2013	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
102358	Fee-for-Service	1649396946	1649396946	1	1	JACOB & HENEIN INC A MEDICAL	6/12/2017	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORP	2230 LYNN RD	SUITE 230	VENTURA	CA	91360	1984	56	06111	34.20894685	-118.885185	Ventura
102361	Fee-for-Service	1366019531	1366019531	1	1	JASON ROOS DO A PROFESSIOINA	11/2/2021	207YX0905X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	805 W ACEQUIA AVE	1B	VISALIA	CA	93291	6162	54	06107	36.32895	-119.30031	Tulare County
102388	Fee-for-Service	1316597693	1316597693	1	1	JOON CHOI MD A PROFESSIONAL	1/27/2025	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
102393	Fee-for-Service	1225184245	1225184245	1	1	JACOBS, CHARLOTTE MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	27593	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
102405	Fee-for-Service	1477594067	1477594067	1	1	JAIN, SANJIV K MD	10/31/1989	207L00000X	NA	Other	026	PHYSICIANS	47841	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
102406	Fee-for-Service	1639436454	1639436454	1	1	JOHNSON, CONSTANCE L	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	735 PINE ST	None	PASO ROBLES	CA	93446	2857	40	06079	35.62232732	-120.6885158	San Luis Obispo County
102433	Fee-for-Service	1053518480	1053518480	1	1	JIYAMAPA, JULIA M MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106302	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
102442	Fee-for-Service	1477870285	1477870285	1	1	JILANI, JAWAD A DO	1/4/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	None	36.19740597	-115.1207123	Clark County
102555	Fee-for-Service	1235510710	1235510710	1	1	JENNIFER LEONIAK DO INC	11/10/2016	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	13410	41	Internal Medicine	0	In state provider	None	1199 DELBON AVE	SUITE 5	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
102606	Fee-for-Service	1710212030	1710212030	1	1	JAMES, MOLLY B MD	5/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	109424	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
102664	Fee-for-Service	1972696573	1972696573	1	1	JIMENEZ, FRANCISCO A MD	4/11/2016	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40305	01	General Practice	0	In state provider	None	6517 EASTERN AVE	None	BELL GARDENS	CA	90201	3003	19	06037	33.97370784	-118.1640782	Los Angeles County
102679	Fee-for-Service	1669722708	1669722708	1	1	JACKSON, ANTHONY I LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	73831	-	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
102774	Fee-for-Service	1760702799	1760702799	1	1	JOLENE YEHL M.D.	3/11/2015	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
102801	Fee-for-Service	1689745416	1689745416	1	1	JONAS, THOMAS A OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2545 E BIDWELL ST	STE 160	FOLSOM	CA	95630	6442	34	06067	38.659932	-121.1314185	Sacramento County
102844	Fee-for-Service	1235510710	1235510710	1	1	JENNIFER LEONIAK DO INC	11/10/2016	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	13410	77	Infectious Disease	0	In state provider	None	1199 DELBON AVE	SUITE 5	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
102845	Fee-for-Service	1083795660	1083795660	1	1	JONES, MAGGIE MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81693	01	General Practice	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
102850	Fee-for-Service	1245767664	1245767664	1	1	JOHNSON, BRITTANY N DO	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18462	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
102863	Fee-for-Service	1619185584	1619185584	1	1	JOSHI, AJAY K MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100423	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
102868	Fee-for-Service	1487868105	1487868105	1	1	JOHNSTON,BRADFORD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET STREET	None	PORTLAND	OR	97216	2599	00	None	45.51158947	-122.5586205	Multnomah County
102880	Fee-for-Service	1598931677	1598931677	1	1	JAYATILAKA, MATTHEW G MD	1/1/1979	173000000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	1760 TERMINO AVE	STE 116	LONG BEACH	CA	90804	2151	19	06037	33.78889871	-118.1458784	Los Angeles County
102953	Fee-for-Service	1972696573	1972696573	1	1	JIMENEZ, FRANCISCO A MD	4/11/2016	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40305	08	Family Practice	0	In state provider	None	6517 EASTERN AVE	None	BELL GARDENS	CA	90201	3003	19	06037	33.97370784	-118.1640782	Los Angeles County
103042	Fee-for-Service	1225184021	1225184021	1	1	JOHNSON, MICHAEL P LCSW	12/17/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15301 TYLER FOOTE RD	None	NEVADA CITY	CA	95959	9318	29	06057	39.36622661	-121.0368658	Nevada County
103109	Fee-for-Service	1265565840	1265565840	1	1	JUSTICE, LINDA M LMFT	10/10/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	33557	-	NOT APPLICABLE	0	In state provider	None	201 A ST	None	SAN DIEGO	CA	92101	4003	37	06073	32.7187985	-117.1626435	San Diego County
103151	Fee-for-Service	1619185584	1619185584	1	1	JOSHI, AJAY K MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100423	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
103188	Fee-for-Service	1609134584	1609134584	1	2	JACOBO, CRYSTAL LMFT	4/13/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5053 LA MART DR	105	RIVERSIDE	CA	92507	5993	33	06065	33.95818206	-117.3320081	Riverside County
103196	Fee-for-Service	1225278385	1225278385	1	1	JOHNSON, ANDRIA D MD	2/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107237	01	General Practice	0	In state provider	None	3100 TELEGRAPH AVE	SUITE 2102	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
103243	Fee-for-Service	1568542934	1568542934	1	1	JAIN, SHAILY MD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
103250	Fee-for-Service	1710381264	1710381264	1	1	JAKEISHA TAYLOR GOSTON NP	10/27/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
103265	Fee-for-Service	1033765060	1033765060	1	1	JOHN C NELSON MD INC	9/23/2019	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
103400	Fee-for-Service	1952456352	1952456352	1	1	JAIN, VIVEKANAND MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54572	None	None	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 107	CONCORD	CA	94520	1650	07	06013	37.98507961	-122.034189	Contra Costa County
103531	Fee-for-Service	1568542934	1568542934	1	1	JAIN, SHAILY MD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
103605	Fee-for-Service	1376819433	1376819433	1	1	JACOBS, JULIE D MD	4/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	39969	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
103646	Fee-for-Service	1306340757	1306340757	1	1	JI, MENGXI MD	6/29/2022	207L00000X	NA	Other	026	PHYSICIANS	165261	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103690	Fee-for-Service	1205366994	1205366994	1	1	JONES-RUBIN, DESIREE M MD	12/22/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	191640	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
103745	Fee-for-Service	1316217375	1316217375	1	1	JK LOOMIS CORPORATION A	3/5/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9418	08	Family Practice	0	In state provider	MEDICAL CORPORATION	3801 KATELLA AVE	STE 222	LOS ALAMITOS	CA	90720	3365	30	06059	33.80318951	-118.066068	Orange County
103935	Fee-for-Service	1881276301	1881276301	1	1	JOHNSON, SUZANNE L NP	10/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
103939	Fee-for-Service	1447218342	1447218342	1	1	JAYARAM, PRATHIMA K MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106956	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
103997	Fee-for-Service	1972758001	1972758001	1	1	JOHNSON, CHRISTA M	6/30/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
104032	Fee-for-Service	1427275270	1427275270	1	1	JACABAN, DAVID A OT	5/23/2011	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
104033	Fee-for-Service	1285786087	1285786087	1	1	JACKSON, KAREN S MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67191	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
104041	Fee-for-Service	1235185653	1235185653	1	1	JACKSON, CYNTHIA L PHD	1/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	14155	-	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
104160	Fee-for-Service	1689058448	1689058448	1	1	JOOS, KIT B DO	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
104183	Fee-for-Service	1336725472	1336725472	1	1	JARMUTH- NEWMAN, SENDA LCSW	4/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
104210	Fee-for-Service	1720320542	1720320542	1	1	JIMENEZ, MICHAEL ANGEL MD	1/26/2013	208600000X	NA	General Surgery	026	PHYSICIANS	120714	02	General Surgery	0	In state provider	A MEDICAL CORPORATION	3628 E IMPERIAL HWY	STE 401	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
104214	Fee-for-Service	1700537396	1700537396	1	1	JUVAN HOME HEALTH CARE	6/12/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2050 W CHAPMAN AVE	SUITE 287	ORANGE	CA	92868	2696	30	06059	33.78787054	-117.87498	Orange County
104277	Fee-for-Service	1225615966	1225615966	1	1	JONES, DANIELLE MD	7/2/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	192580	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
104321	Fee-for-Service	1396942470	1396942470	1	1	JAFFRAY, JULIE A MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124023	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
104331	Fee-for-Service	1811637564	1811637564	1	1	JENKINS, NATHANIEL MD	8/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	189343	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
104359	Fee-for-Service	1013929900	1013929900	1	1	JARAICIE, ELIAS A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80943	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
104526	Fee-for-Service	1154588374	1154588374	1	1	JOSEPHSON, JOHN W MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115946	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
104576	Fee-for-Service	1821022203	1821022203	1	1	JUNICHI TAMAI M.D	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
104609	Fee-for-Service	1396942470	1396942470	1	1	JAFFRAY, JULIE A MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124023	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
104699	Fee-for-Service	1659183838	1659183838	1	1	JIVIDEN, MELISSA N LMFT	1/25/2025	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
104723	Fee-for-Service	1205833688	1205833688	1	1	JONES, JEROME H MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28381	40	Pediatrics	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
104745	Fee-for-Service	1366052805	1366052805	1	1	JORDAN, DEADRA NP	6/24/2024	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
104771	Fee-for-Service	1346338282	1346338282	1	2	J AND P HOMES INC	7/5/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8472 SAN CAPISTRANO WAY	None	BUENA PARK	CA	90620	3021	30	06059	33.8403304	-118.0174468	Orange County
104780	Fee-for-Service	1720172661	1720172661	1	1	JA, BENJAMIN OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
104812	Fee-for-Service	1578665279	1578665279	1	1	JAPANWALLA, MAHEJABEEN MD	4/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165484	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
104819	Fee-for-Service	1528695939	1528695939	1	1	JAVAHERIFAR, SARAH MD	6/23/2023	207R00000X	NA	Other	026	PHYSICIANS	180755	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
104868	Fee-for-Service	1083741250	1083741250	1	1	J & J CARE CENTERS INC	8/14/1985	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2525 DELMAR AVE	None	PENRYN	CA	95663	9543	31	06061	38.84630475	-121.2149336	Placer County
104896	Fee-for-Service	1396942470	1396942470	1	1	JAFFRAY, JULIE A MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124023	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
104898	Fee-for-Service	1801217435	1801217435	1	3	J L AND J INC	3/21/2018	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
104910	Fee-for-Service	1619235074	1619235074	1	1	JALIL, SHEMI S MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131789	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
104936	Fee-for-Service	1033297718	1033297718	1	1	JOGLEKAR, AMITABH MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73402	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
104947	Fee-for-Service	1821091380	1821091380	1	1	JAR CV ENTERPRISES INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11681 STERLING AVE	STE 5	RIVERSIDE	CA	92503	4975	33	06065	33.89516914	-117.4861799	Riverside County
104997	Fee-for-Service	1427043744	1427043744	1	1	JAMES CLEMENS	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 LINCOLN CIR SE	None	ORANGE CITY	IA	51041	1836	00	None	42.99560241	-96.04464101	Sioux County
105019	Fee-for-Service	1144411810	1144411810	1	1	JAFRI, NAZIA F MD	7/5/2011	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	107236	None	None	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
105052	Fee-for-Service	1548498397	1548498397	1	1	JULIE, IAN M MD	6/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125576	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
105067	Fee-for-Service	1730888405	1730888405	1	1	JENSEN, KAITLIN PT	10/31/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1906 VISTA DEL LAGO DR	STE A	VALLEY SPRINGS	CA	95252	9700	05	06009	38.16810805	-120.8383709	Calaveras County
105104	Fee-for-Service	1649333444	1649333444	1	1	JOHNSON, DEBORAH S LCSW	9/11/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6300 E HWY 20	None	LUCERNE	CA	95458	8500	17	06033	39.08645757	-122.7925572	Lake County
105128	Fee-for-Service	1265729818	1265729818	1	1	JEONG, DAE HYOUN MD	1/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	142623	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
105217	Fee-for-Service	1790120905	1790120905	1	1	JONES, AMY M DO	1/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14087	09	Gynecology (D.O. only)	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
105225	Fee-for-Service	1336162486	1336162486	1	1	JOSHI, BIPIN K MD	10/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	44090	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
105247	Fee-for-Service	1073608121	1073608121	1	1	J. CHANDRASEKHAR INC	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89686	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
105252	Fee-for-Service	1821162132	1821162132	1	1	JIMENEZ, MARTIN MD	11/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78823	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
105288	Fee-for-Service	1891292942	1891292942	1	1	JASIM, AFREEN MD	7/22/2024	390200000X	NA	Other	026	PHYSICIANS	174972	22	Pathology (M.D. only)	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
105304	Fee-for-Service	1558090670	1558090670	1	1	JIMENEZ, KAYLA J PSYD	10/26/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
105313	Fee-for-Service	1720513542	1720513542	1	1	JAVVAJI, SHYAM MD	10/23/2020	208M00000X	NA	Other	026	PHYSICIANS	162329	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
105418	Fee-for-Service	1598909806	1598909806	1	1	JOSE RELOBA, DJANA C MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114235	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
105487	Fee-for-Service	1144774928	1144774928	1	1	JOHNSON, SAMANTHA M OD	8/22/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6134 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2923	19	06037	33.98457344	-118.2251414	Los Angeles County
105513	Fee-for-Service	1336162486	1336162486	1	1	JOSHI, BIPIN K MD	10/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	44090	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
105559	Fee-for-Service	1306519228	1306519228	1	1	JONES, JANAE DOULA	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	41	06081	0	0	None
105618	Fee-for-Service	1619273364	1619273364	1	1	JUAN, GEORGE MD	10/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141456	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
105718	Fee-for-Service	1285803460	1285803460	1	1	JOSEPH, MARY P MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102706	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
105904	Fee-for-Service	1083094049	1083094049	1	1	JETT, SAMANTHA A	9/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
106007	Fee-for-Service	1801167630	1801167630	1	1	JUCEDA LLC	4/3/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15906 EAST BALLENTINE PL	None	COVINA	CA	91722	3338	19	06037	34.09136656	-117.9363161	Los Angeles County
106031	Fee-for-Service	1114074135	1114074135	1	1	JENNIFER NAISER D.O.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
106034	Fee-for-Service	1104984764	1104984764	1	1	JOHNSON, LINDA A CNM	8/13/1985	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2323 WARD ST	None	BERKELEY	CA	94705	1110	01	06001	37.86023225	-122.2610953	Alameda County
106035	Fee-for-Service	1770738122	1770738122	1	2	JOHNSON, CLAUDIUS LCSW	5/11/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	614 GRAND AVE	SUITE 203	OAKLAND	CA	94610	3554	01	06001	37.80970653	-122.2493811	Alameda County
106051	Fee-for-Service	1114974359	1114974359	1	1	JOHN A SILVERMAN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2675 W TAYLORSVILLE BLVD	None	TAYLORSVILLE	UT	84129	2208	00	None	40.65438556	-111.9571398	Salt Lake County
106085	Fee-for-Service	1902047814	1902047814	1	1	JOLLY, SHASHANK MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126261	None	None	0	In state provider	None	39141 CIVIC CENTER DRIVE	None	FREMONT	CA	94538	5822	01	06001	37.55436307	-121.9764708	Alameda County
106125	Fee-for-Service	1164485967	1164485967	1	1	JUANG, PASCAL SC MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80569	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
106128	Fee-for-Service	1285767475	1285767475	1	1	JIN, ANNA	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84938	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
106189	Fee-for-Service	1326126129	1326126129	1	1	JUNGE, DANIEL P DO	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7195	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
106213	Fee-for-Service	1669605614	1669605614	1	1	JIMENEZ-GRILLO, JEANETTE NP	11/10/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
106341	Fee-for-Service	1881071140	1881071140	1	1	JOHNSON, WILLIAM J LMFT	12/27/2022	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
106414	Fee-for-Service	1821032871	1821032871	1	1	JUNG, MARY S MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73312	41	Internal Medicine	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
106488	Fee-for-Service	1487140869	1487140869	1	1	JUSTIN THIEN LEE, MD INC	8/29/2018	261QM2500X	NA	Other	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
106503	Fee-for-Service	1821476797	1821476797	1	1	JENSEN, BRANDON D MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
106569	Fee-for-Service	1326006941	1326006941	1	1	JAHAN, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52263	25	Physical Medicine and Rehabilitation	0	In state provider	None	5555 RESERVOIR DR	STE 208	SAN DIEGO	CA	92120	5187	37	06073	32.77628471	-117.0563688	San Diego County
106612	Fee-for-Service	1417908757	1417908757	1	1	JOSE NOVOA M.D.	12/20/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	890 OAK ST SE	None	SALEM	OR	97301	3905	00	None	44.932887	-123.0341175	Marion County
106645	Fee-for-Service	1336830991	1336830991	1	1	JOHNSON, TANIKA BIRTH DOULA	1/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
106748	Fee-for-Service	1013448588	1013448588	1	1	JOHN, MIRA M MD	8/5/2024	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
106868	Fee-for-Service	1477235653	1477235653	1	1	J & J MEDICAL GROUP INC	10/2/2023	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	None	None	0	In state provider	None	17507 CRENSHAW BLVD	None	TORRANCE	CA	90504	3403	19	06037	33.871635	-118.326516	Los Angeles County
106878	Fee-for-Service	1073778247	1073778247	1	1	JAIN, PAYAL A MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110118	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
106948	Fee-for-Service	1235259359	1235259359	1	1	JONES-KAZAN, DENISE LCSW	8/10/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6500 FAIRMOUNT AVE	STE 9	EL CERRITO	CA	94530	3661	07	06013	37.90115255	-122.3007746	Contra Costa County
106999	Fee-for-Service	1265680375	1265680375	1	1	JOHNSON, MATTHEW T MD	3/3/2021	208800000X	NA	Other	026	PHYSICIANS	171156	None	None	0	In state provider	None	1427 MAGNOLIA AVE	None	CHICO	CA	95926	3226	04	06007	39.74063543	-121.8499003	Butte County
107100	Fee-for-Service	1073520342	1073520342	1	1	JAIN, VIJAY K MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68818	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
107130	Fee-for-Service	1487179354	1487179354	1	1	JIANG, PHILIP DPM	8/11/2023	213ES0103X	NA	Other	026	PHYSICIANS	None	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
107176	Fee-for-Service	1306989223	1306989223	1	1	JAMES, TODD C MD	2/5/2019	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	159787	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
107230	Fee-for-Service	1679952436	1679952436	1	1	JACKSON, KATHERINE M MD	12/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	177164	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
107316	Fee-for-Service	1093985830	1093985830	1	1	JANZEN, ROBIN R L MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99430	None	None	0	In state provider	None	7050 N RECREATION	STE 102	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
107322	Fee-for-Service	1902918287	1902918287	1	1	JACKSON, SHARI M MD	7/24/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156563	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
107336	Fee-for-Service	1487106225	1487106225	1	1	JAMADAR, ROSHNI NP	2/28/2022	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
107419	Fee-for-Service	1649235201	1649235201	1	1	JEFFREY, NICOLE MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87251	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHORNE AVE	STE 301	OAKLAND	CA	94609	3113	01	06001	37.82079728	-122.2633226	Alameda County
107435	Fee-for-Service	1417031998	1417031998	1	2	JORGE, BERNARD S MD	2/16/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	33386	-	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
107576	Fee-for-Service	1629064076	1629064076	1	1	JOHNSON, PAUL MD	7/31/1989	207L00000X	NA	Other	026	PHYSICIANS	68329	05	Anesthesiology	0	In state provider	None	3939 J ST	STE 310	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
107592	Fee-for-Service	1871660613	1871660613	1	1	JACKSON, KENT R MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78820	20	Orthopedic Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
107639	Fee-for-Service	1821172818	1821172818	1	1	JEREB, DONALD J MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45764	08	Family Practice	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
107700	Fee-for-Service	1992895288	1992895288	1	1	JACQUEZ, DIANE MARIE RN	12/6/2005	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8318 BELLA VISTA DR	None	RANCHO CUCAMONGA	CA	91701	1332	36	06071	34.161167	-117.6232392	San Bernardino County
107761	Fee-for-Service	1538143078	1538143078	1	1	JOYE, NANCY R MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33132	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
107827	Fee-for-Service	1497107387	1497107387	1	1	JONES, AARON MD	7/7/2020	390200000X	NA	Other	026	PHYSICIANS	152551	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
107856	Fee-for-Service	1750856019	1750856019	1	1	JIANG, JAY R OD	1/6/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 W DUARTE RD # B	None	ARCADIA	CA	91007	7332	19	06037	34.12630473	-118.05356	Los Angeles County
107874	Fee-for-Service	1659831725	1659831725	1	1	JIMENEZ, JOHNNY NP	7/18/2023	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
107904	Fee-for-Service	1871237420	1871237420	1	1	JABBARI, ROUJIN PSYD	6/16/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
107924	Fee-for-Service	1881766186	1881766186	1	1	JONES, CHRISTIAN C MD	2/15/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	49251	None	None	0	In state provider	None	200 COTTAGE AVE	STE 201	MANTECA	CA	95336	4935	39	06077	37.79956104	-121.1982472	San Joaquin County
107989	Fee-for-Service	1992895288	1992895288	1	1	JACQUEZ, DIANE MARIE RN	12/6/2005	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8318 BELLA VISTA DR	None	RANCHO CUCAMONGA	CA	91701	1332	36	06071	34.161167	-117.6232392	San Bernardino County
108001	Fee-for-Service	1649299876	1649299876	1	1	JINAMORNPHONGS, SUCHAYA	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92141	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
108076	Fee-for-Service	1730130105	1730130105	2	1	JAIN, SANJAY MD	2/4/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65344	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
108136	Fee-for-Service	1629384656	1629384656	1	1	JAIMES-VILLANUEVA, DENISE R	1/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BATH ST	SUITE 202	SANTA BARBARA	CA	93105	4351	42	06083	34.43168847	-119.7234694	Santa Barbara County
108146	Fee-for-Service	1184777344	1184777344	1	2	JMJ HEALTHCARE INC	12/17/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8640 BRENTWOOD BLVD	SUITE D	BRENTWOOD	CA	94513	5659	07	06013	37.92650142	-121.6913814	Contra Costa County
108400	Fee-for-Service	1932329265	1932329265	1	1	JANZEN, MARK L MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	90203	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
108427	Fee-for-Service	1649615287	1649615287	1	1	JACKSON, DOREEN O MD	4/9/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	171636	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
108479	Fee-for-Service	1336174127	1336174127	1	1	JOHNSON, LELAND D	12/26/2006	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ACCESS SOLUTIONS	8865 AIRPORT RD	STE A	REDDING	CA	96002	9382	45	06089	40.544733	-122.3028258	Shasta County
108502	Fee-for-Service	1477787992	1477787992	1	1	JACLYN K TAYLOR M.D.	6/29/2016	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
108525	Fee-for-Service	1649601253	1649601253	1	1	JOHNSON, STEPHEN K NP	6/1/2023	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
108581	Fee-for-Service	1699456640	1699456640	1	1	JONES, JUNELLE M CRNA	2/11/2025	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
108675	Fee-for-Service	1710480322	1710480322	1	1	JUSTINE G BARANDINO	3/21/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7034 LARCHMONT DRIVE	None	NORTH HIGHLANDS	CA	95660	3420	34	06067	38.695671	-121.3740135	Sacramento County
108724	Fee-for-Service	1063477883	1063477883	1	1	JACOBS, RICHARD A MD	6/29/1989	207R00000X	NA	Other	026	PHYSICIANS	30614	01	General Practice	0	In state provider	None	533 PARNASSUS AVE	# U125	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
108740	Fee-for-Service	1629164900	1629164900	1	1	JIMENO, ALBERTO MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30730	41	Internal Medicine	0	In state provider	None	6061 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4428	19	06037	34.01684469	-118.1402965	Los Angeles County
108744	Fee-for-Service	1588684641	1588684641	1	1	JACKSON, ETHAN C MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62485	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 108	LOS GATOS	CA	95032	7691	43	06085	37.25302151	-121.966891	Santa Clara County
108766	Fee-for-Service	1518121755	1518121755	1	1	JAZI BURKE, LIDA	12/24/2012	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
108785	Fee-for-Service	1841430139	1841430139	1	1	JACKSON, JOANNA M DO	1/21/2022	207P00000X	NA	Other	026	PHYSICIANS	18672	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
108805	Fee-for-Service	1134627375	1134627375	1	1	JO, KAHEE MD	10/30/2022	207R00000X	NA	Other	026	PHYSICIANS	176608	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
108818	Fee-for-Service	1942628128	1942628128	1	1	JAIN, MEGHAN MD	9/10/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138547	36	Psychiatry	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
108829	Fee-for-Service	1770742710	1770742710	1	1	JAYAKUMAR, ARCHANA MD	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115670	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
108855	Fee-for-Service	1215443411	1215443411	1	1	JENNESS DIALYSIS LLC	6/9/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1951 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4158	37	06073	33.112323	-117.120256	San Diego County
108918	Fee-for-Service	1083870299	1083870299	1	1	JUNG, JENNIFER OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 E 5TH STREET	None	LONG BEACH	CA	90802	2489	19	06037	33.7727055	-118.190187	Los Angeles County
108964	Fee-for-Service	1710480322	1710480322	1	1	JUSTINE G BARANDINO	3/21/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7034 LARCHMONT DRIVE	None	NORTH HIGHLANDS	CA	95660	3420	34	06067	38.695671	-121.3740135	Sacramento County
108992	Fee-for-Service	1013750157	1013750157	1	1	JAMAL ADAMS LICENSED PROFESS	11/8/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RAPY	2006 W 95TH ST	None	LOS ANGELES	CA	90047	3719	19	06037	33.94977081	-118.3137471	Los Angeles County
109045	Fee-for-Service	1114216371	1114216371	1	1	JAMSHED, SAMREEN MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127111	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA DR	SUITE 140	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
109067	Fee-for-Service	1083809651	1083809651	1	1	JUSTINE SHERMAN & ASSOC INC	9/19/2024	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
109071	Fee-for-Service	1821671124	1821671124	1	1	JUAN CARLOS RAMIREZ MD, INC.	9/22/2021	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3355 E GAGE AVE	None	HUNTINGTON PARK	CA	90255	5530	19	06037	33.98001244	-118.2055175	Los Angeles County
109118	Fee-for-Service	1770742710	1770742710	1	1	JAYAKUMAR, ARCHANA MD	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115670	29	Pulmonary Diseases (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
109221	Fee-for-Service	1588970115	1588970115	1	1	JUNG, MATTHEW W MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124125	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
109242	Fee-for-Service	1013491810	1013491810	1	1	JOHNSON, JENNY L NP	9/27/2018	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
109260	Fee-for-Service	1720426901	1720426901	1	1	JAINCHILL, AMANDA L MD	5/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	141541	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
109297	Fee-for-Service	1720470974	1720470974	1	1	JORDAN VALLEY MEDICAL CENTER	7/3/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LP	3000 N TRIUMPH BLVD	None	LEHI	UT	84043	4999	00	None	40.42593191	-111.8802049	Utah County
109300	Fee-for-Service	1154436533	1154436533	1	1	JONES, ALAN K DPM	2/23/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
109347	Fee-for-Service	1255450656	1255450656	1	1	JAMES EARL ROSS JR MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 DALLAS ST	None	SAN ANTONIO	TX	78205	1201	00	None	29.43317376	-98.49236007	Bexar County
109405	Fee-for-Service	1013539238	1013539238	1	1	JOURNEY HOME HEALTH CARE INC	1/15/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17703 SATICOY ST	None	RESEDA	CA	91335	3350	19	06037	34.20843346	-118.519065	Los Angeles County
109484	Fee-for-Service	1235184367	1235184367	1	1	JOHNSTON, BRIAN D MD	1/30/1982	207P00000X	NA	Other	026	PHYSICIANS	23994	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1520 ARIZONA AVE	None	SANTA MONICA	CA	90404	1208	19	06037	34.02656749	-118.4857708	Los Angeles County
109496	Fee-for-Service	1770024242	1770024242	1	1	JACOB, NEETHU PA-C	5/12/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	57298	-	NOT APPLICABLE	0	In state provider	None	3594 FOURTH AVE	None	SAN DIEGO	CA	92103	4940	37	06073	32.74318084	-117.1615865	San Diego County
109508	Fee-for-Service	1588970115	1588970115	1	1	JUNG, MATTHEW W MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124125	38	Geriatrics	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
109519	Fee-for-Service	1538186044	1538186044	1	1	JONES, RICHARD A MD	5/17/2004	207W00000X	NA	Ophthalmology	026	PHYSICIANS	43646	18	Ophthalmology	0	In state provider	None	4925 J ST	None	SACRAMENTO	CA	95819	3828	34	06067	38.566971	-121.4426385	Sacramento County
109520	Fee-for-Service	1114282076	1114282076	1	1	JENNINGS-DOVER, CHARAY D MD	4/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109084	22	Pathology (M.D. only)	0	In state provider	None	305 PARK CREEK DRIVE	None	CLOVIS	CA	93611	4426	10	06019	36.84077548	-119.7076545	Fresno County
109563	Fee-for-Service	1235317751	1235317751	1	1	JIMENEZ, ARSENIO MD	8/14/2019	207R00000X	NA	Other	086	MEDICAL DIRECTORS	60784	-	NOT APPLICABLE	0	In state provider	None	43322 GINGHAM AVE	STE 104&105	LANCASTER	CA	93535	4569	19	06037	34.67013731	-118.1222748	Los Angeles County
109586	Fee-for-Service	1720470974	1720470974	1	1	JORDAN VALLEY MEDICAL CENTER	7/3/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LP	3000 N TRIUMPH BLVD	None	LEHI	UT	84043	4999	00	None	40.42593191	-111.8802049	Utah County
109624	Fee-for-Service	1437198280	1437198280	1	1	JILL D MILLER	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
109703	Fee-for-Service	1104453372	1104453372	1	1	JIA, ANNIE DO	10/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20766	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
109752	Fee-for-Service	1851553887	1851553887	1	1	JOHNSEN, JACQUELINE A DO	7/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12181	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
109792	Fee-for-Service	1487902524	1487902524	1	1	JAYARAMASWAMY SULOCHANA, SHI	3/17/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	LPA MD	39500 FREMONT BLVD	100	FREMONT	CA	94538	2101	01	06001	37.5448266	-121.9802588	Alameda County
109807	Fee-for-Service	1114282076	1114282076	1	1	JENNINGS-DOVER, CHARAY D MD	4/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109084	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	305 PARK CREEK DRIVE	None	CLOVIS	CA	93611	4426	10	06019	36.84077548	-119.7076545	Fresno County
109814	Fee-for-Service	1770317448	1770317448	1	1	JALLALVANDI, FARRAH NP	10/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
109821	Fee-for-Service	1902000854	1902000854	1	1	JOO, ALLEN I MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106222	68	Hematology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109903	Fee-for-Service	1164500997	1164500997	1	1	JAING, JAMES T MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66564	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
109992	Fee-for-Service	1821278797	1821278797	1	1	JUNGSTEN, MECHELLE D LMFT	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	102668	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
110109	Fee-for-Service	1902000854	1902000854	1	1	JOO, ALLEN I MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106222	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
110166	Fee-for-Service	1689019853	1689019853	1	1	JOLLEY, MARGARET A MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136179	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
110239	Fee-for-Service	1811336027	1811336027	1	1	JARVIS, AMALIA P PSYD	5/29/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
110330	Fee-for-Service	1194942813	1194942813	1	1	JESKE, STEPHANIE J MD	2/11/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	111468	68	Hematology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
110396	Fee-for-Service	1437476629	1437476629	1	1	J RAMIREZ MEDICAL CORP	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	25459	41	Internal Medicine	0	In state provider	None	6128 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4504	19	06037	34.01654908	-118.1391761	Los Angeles County
110462	Fee-for-Service	1952570574	1952570574	1	1	JOVKAR, SAYED MD INC	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55392	18	Ophthalmology	0	In state provider	None	15251 NATIONAL AVE	STE 100	LOS GATOS	CA	95032	2400	43	06085	37.24637433	-121.9500289	Santa Clara County
110564	Fee-for-Service	1952946956	1952946956	1	1	JOSEPH BAPTISTE PORTER, AMEL	2/16/2022	2084P0800X	NA	Psychiatry	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	LE NP	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
110568	Fee-for-Service	1013025071	1013025071	1	1	JAMISON, WENDELL B MD	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17533	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 S B ST	None	LOMPOC	CA	93436	6933	42	06083	34.63860089	-120.4503641	Santa Barbara County
110607	Fee-for-Service	1134200496	1134200496	1	1	JOEL S TIEDER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
110608	Fee-for-Service	1841495892	1841495892	1	1	JANG, SEONAH MD	8/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109839	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
110617	Fee-for-Service	1194942813	1194942813	1	1	JESKE, STEPHANIE J MD	2/11/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	111468	78	Neoplastic Diseases/Oncology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
110685	Fee-for-Service	1437476629	1437476629	1	1	J RAMIREZ MEDICAL CORP	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	25459	45	Nephrology (Renal-Kidney)	0	In state provider	None	6128 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4504	19	06037	34.01654908	-118.1391761	Los Angeles County
110744	Fee-for-Service	1982641494	1982641494	1	1	JAZAREVIC, SLOBODAN MD	12/8/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	176387	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
110788	Fee-for-Service	1134103898	1134103898	1	1	JEPSON, PAUL M MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	23352	34	Urology and Urological Surgery	0	In state provider	None	1050 N STATE ST	None	UKIAH	CA	95482	3414	23	06045	39.1623719	-123.2098216	Mendocino County
110795	Fee-for-Service	1366760514	1366760514	1	1	JABAJI, ZIYAD B MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114231	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
110867	Fee-for-Service	1245541101	1245541101	1	1	JENSEN, ALESHA J OD	1/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5151 N PALM AVE	STE 150	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
110902	Fee-for-Service	1962029371	1962029371	1	1	JOANNA ROSE BENAVIDEZ	2/8/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INICAL PSYCHOLOGIST	8133 ROYAL GORGE DR.	None	SAN DIEGO	CA	92119	1137	37	06073	32.81537336	-117.0512751	San Diego County
110932	Fee-for-Service	1942203609	1942203609	1	1	JENKINS, DONELLA MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54017	08	Family Practice	0	In state provider	None	1180 N INDIAN CANYON DR	STE E421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
110951	Fee-for-Service	1215347703	1215347703	1	1	JESSICA TANENBAUM	2/26/2023	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
111036	Fee-for-Service	1811343791	1811343791	1	1	JNO BAPTISTE, NATASHYA NP	5/26/2017	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7720 N FRESNO ST	STE 104	FRESNO	CA	93720	2407	10	06019	36.85068226	-119.7836282	Fresno County
111068	Fee-for-Service	1881221182	1881221182	1	1	JOHL, SUNNY MD	12/20/2024	207R00000X	NA	Other	026	PHYSICIANS	177838	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
111080	Fee-for-Service	1811634819	1811634819	1	1	JOHNSON, MONIQUE	7/21/2023	227800000X	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
111214	Fee-for-Service	1679715916	1679715916	1	1	JAIN, PREIYA D MD	7/29/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	127604	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 S WELLS RD	SUITE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
111249	Fee-for-Service	1285223552	1285223552	1	3	JIVA HEALTH, INC	7/26/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	1620 PENNSYLVANIA AVE	SUITE B	FAIRFIELD	CA	94533	3551	48	06095	38.2594713	-122.0498661	Solano County
111317	Fee-for-Service	1760510820	1760510820	1	1	JOHNSON, DEBRA A PHD A	12/26/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGY CORPORATION	615 15TH ST	None	MODESTO	CA	95354	2510	50	06099	37.6406505	-120.9914592	Stanislaus County
111326	Fee-for-Service	1699888263	1699888263	1	1	JUBY, MICHAEL WILLIAM MD	7/6/1994	207P00000X	NA	Other	026	PHYSICIANS	79396	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
111374	Fee-for-Service	1164539433	1164539433	2	1	JINDAL, HIRA L MD	12/29/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	26281	41	Internal Medicine	0	In state provider	None	711 W COLLEGE ST	STE 590	LOS ANGELES	CA	90012	1256	19	06037	34.06541412	-118.2414102	Los Angeles County
111407	Fee-for-Service	1518025907	1518025907	1	1	JOHNSON, BRENDA R PHD	5/15/2009	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3252 HOLIDAY COURT	SUITE 100	LA JOLLA	CA	92037	1807	37	06073	32.8705156	-117.2323734	San Diego County
111441	Fee-for-Service	1477763472	1477763472	1	1	JAFFE, MARK E MD	10/18/2024	2084F0202X	NA	Psychiatry	086	MEDICAL DIRECTORS	75071	-	NOT APPLICABLE	0	In state provider	None	28632 ROADSIDE DR	210	AGOURA HILLS	CA	91301	6091	19	06037	34.14375168	-118.7497422	Los Angeles County
111449	Fee-for-Service	1467986356	1467986356	1	1	JAIN, MONICA MD	7/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159594	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
111538	Fee-for-Service	1285223552	1285223552	1	3	JIVA HEALTH, INC	7/26/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	1620 PENNSYLVANIA AVE	SUITE B	FAIRFIELD	CA	94533	3551	48	06095	38.2594713	-122.0498661	Solano County
111551	Fee-for-Service	1619133097	1619133097	1	1	JARASA, JENNIFER T MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129826	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
111596	Fee-for-Service	1831520584	1831520584	1	1	JONES, JOANNA V NP	9/17/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8001 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
111612	Fee-for-Service	1699888263	1699888263	1	1	JUBY, MICHAEL WILLIAM MD	7/6/1994	207P00000X	NA	Other	026	PHYSICIANS	79396	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
111648	Fee-for-Service	1649562612	1649562612	1	1	JIN, MIN MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129866	41	Internal Medicine	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
111725	Fee-for-Service	1992890149	1992890149	1	1	JARAVATA, DANILO V MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	52971	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
111728	Fee-for-Service	1326162991	1326162991	1	1	JOHNSON, SUZANNE E DO	10/4/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6457	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
111826	Fee-for-Service	1285223552	1285223552	1	3	JIVA HEALTH, INC	7/26/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1620 PENNSYLVANIA AVE	SUITE B	FAIRFIELD	CA	94533	3551	48	06095	38.2594713	-122.0498661	Solano County
112005	Fee-for-Service	1487938668	1487938668	1	1	JOHNSON, REBECCA LMFT	6/15/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
112022	Fee-for-Service	1578975637	1578975637	1	1	JOSIC, TATJANA DO	4/22/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	14286	None	None	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
112044	Fee-for-Service	1649703075	1649703075	1	1	JASPER, KYLE H MD	5/22/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184429	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
112298	Fee-for-Service	1902471204	1902471204	1	1	JAVIER, ELENA A OT	7/18/2022	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
112372	Fee-for-Service	1346390713	1346390713	1	1	JENNINGS, RONALD M PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
112503	Fee-for-Service	1487065108	1487065108	1	1	JONES, CAMERON P MD	4/9/2021	207L00000X	NA	Other	026	PHYSICIANS	170600	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
112511	Fee-for-Service	1184993289	1184993289	1	1	JUDSON, KRISTEN M	1/4/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2702 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
112533	Fee-for-Service	1407846025	1407846025	1	1	JONES, MICHAEL W MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	34871	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	699 MAIN ST	STE C	PLACERVILLE	CA	95667	5720	09	06017	38.73029575	-120.7911737	El Dorado County
112564	Fee-for-Service	1922751734	1922751734	1	1	JAISWAL, PRASHANT PT	4/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LANE	100	SAN BERNARDINO	CA	92408	3238	36	06071	34.0659135	-117.289215	San Bernardino County
112581	Fee-for-Service	1487761706	1487761706	1	1	JAMAL A QURESHI MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST FRANCIS	3237 S 16TH ST	None	MILWAUKEE	WI	53215	4526	00	None	42.98553012	-87.93382656	Milwaukee County
112593	Fee-for-Service	1487037230	1487037230	1	1	JESSUP, RENEE C L LCSW	2/2/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
112639	Fee-for-Service	1801942008	1801942008	1	1	JAFFE, JULIE M MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112966	78	Neoplastic Diseases/Oncology	0	In state provider	None	1669 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1523	44	06087	36.99028149	-121.9807642	Santa Cruz County
112805	Fee-for-Service	1033579925	1033579925	1	1	JOHNSTON, CHRISTOPHER W	8/14/2017	No Taxonomy Provided	NA	None	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
112902	Fee-for-Service	1932722725	1932722725	1	1	JIMENEZ STUART, PAUL	3/14/2024	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
112927	Fee-for-Service	1801942008	1801942008	1	1	JAFFE, JULIE M MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112966	68	Hematology	0	In state provider	None	1669 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1523	44	06087	36.99028149	-121.9807642	Santa Cruz County
112994	Fee-for-Service	1154474781	1154474781	1	1	JIMENEZ, DOUGLAS B MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73110	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
113079	Fee-for-Service	1811963184	1811963184	1	1	JULKA, KARAN MD	7/24/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	167939	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
113274	Fee-for-Service	1528176096	1528176096	1	1	JALOVAARA, ROSEMARY A LMFT	6/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	437 ROBERTS	None	PACIFICA	CA	94044	3248	41	06081	37.60286563	-122.4964805	San Mateo County
113369	Fee-for-Service	1639438997	1639438997	1	1	JEDD, ANTHONY S MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147011	30	Radiology	0	In state provider	None	300 PASTUER DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
113378	Fee-for-Service	1245541119	1245541119	1	1	JANI, AARTI S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135374	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113385	Fee-for-Service	1295715134	1295715134	1	1	JACOBY DAVID AM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27649	41	Internal Medicine	0	In state provider	None	1036 LAUREL ST	None	SAN CARLOS	CA	94070	3919	41	06081	37.50072877	-122.2542403	San Mateo County
113412	Fee-for-Service	1225318876	1225318876	1	1	JAVIDAN, YASHAR MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116502	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
113565	Fee-for-Service	1003895962	1003895962	1	1	JACOBS,HENRY JAMES MD	3/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 E UNIVERSITY	None	DE MOINES	IA	50316	0000	00	None	41.60040747	-93.609657	Polk County
113595	Fee-for-Service	1700291390	1700291390	1	1	JONES, CHRISTOPHER W MD	9/13/2021	208M00000X	NA	Other	026	PHYSICIANS	172585	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
113598	Fee-for-Service	1275023780	1275023780	1	1	JIANG, WEIZHENG MD	7/21/2021	207R00000X	NA	Other	026	PHYSICIANS	173641	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
113824	Fee-for-Service	1891870556	1891870556	1	1	JEN, HANLON B MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65574	02	General Surgery	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
113951	Fee-for-Service	1780875914	1780875914	1	1	JAYARAJ, PRASH F MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95962	None	None	0	In state provider	None	1701 CESAR E CHAVEZ AVE	STE 560	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
113972	Fee-for-Service	1326178856	1326178856	1	1	JOUNG, WON J LAC	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1730 SEPULVEDA BLVD	STE 2	TORRANCE	CA	90501	6902	19	06037	33.81701583	-118.3091173	Los Angeles County
114059	Fee-for-Service	1003011941	1003011941	1	1	JUNG, EDWARD MD	2/5/2019	2085R0001X	NA	Other	026	PHYSICIANS	104806	32	Radiation Therapy (D.O. only)	0	In state provider	None	4500 MORNING DR	STE 105	BAKERSFIELD	CA	93306	7276	15	06029	35.39343836	-118.9166214	Kern County
114131	Fee-for-Service	1346514189	1346514189	1	1	JOAO PROLA NETTO	8/21/2018	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
114206	Fee-for-Service	1073656823	1073656823	1	1	JENKINS, ELIZABETH D	10/1/2007	No Taxonomy Provided	NA	None	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
114222	Fee-for-Service	1104852870	1104852870	1	1	JENG, BENNIE H MD	7/12/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79800	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
114255	Fee-for-Service	1063519486	1063519486	1	1	JACKSON, ANITA C MD	10/11/2019	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	53675	08	Family Practice	0	In state provider	None	44274 GEORGE CUSHMAN CT	212	TEMECULA	CA	92592	5945	33	06065	33.48313254	-117.0888293	Riverside County
114260	Fee-for-Service	1861028680	1861028680	1	1	JOHNSON, MELINDA LMFT	2/15/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5655 LINDERO CANYON RD	SUITE 326	WESTLAKE VILLAGE	CA	91362	4051	19	06037	34.15322429	-118.7996645	Los Angeles County
114261	Fee-for-Service	1689945362	1689945362	1	1	JOHNSON, TYLER P MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114397	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
114283	Fee-for-Service	1972283372	1972283372	1	1	JOY AND LOVE HOME CARE, LLC	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1178 EVERGREEN LANE	None	VISTA	CA	92084	1015	37	06073	33.25596283	-117.229794	San Diego County
114288	Fee-for-Service	1760942825	1760942825	1	1	JOB, KENNETH MD	8/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180062	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
114363	Fee-for-Service	1558320739	1558320739	1	1	JENSEN, STEEN W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75001	02	General Surgery	0	In state provider	None	1060 VALLEY VIEW DR	None	QUINCY	CA	95971	9510	32	06063	39.94051434	-120.9614275	Plumas County
114377	Fee-for-Service	1245215144	1245215144	1	1	JO, WON-SEOK MD	1/26/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	91260	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
114457	Fee-for-Service	1689685885	1689685885	1	1	JACOBS, MEGAN S MD	1/21/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	83537	None	None	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
114483	Fee-for-Service	1306027669	1306027669	1	1	JUAN F. FERNANDEZ MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4305 N MESA ST	STE A	EL PASO	TX	79902	1124	00	None	31.79736	-106.511277	El Paso County
114489	Fee-for-Service	1669799078	1669799078	1	1	JOSEPH, NANCY M MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121404	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
114509	Fee-for-Service	1497791610	1497791610	1	1	JASON CHARLES WELLS M.D.	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
114551	Fee-for-Service	1689945362	1689945362	1	1	JOHNSON, TYLER P MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114397	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
114553	Fee-for-Service	1932187143	1932187143	1	1	JETHANANDANI, VIJAY MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128480	36	Psychiatry	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
114630	Fee-for-Service	1174894935	1174894935	1	1	JONG, LAURA TOYONO	6/25/2012	193400000X	NA	Other	026	PHYSICIANS	82124	None	None	0	In state provider	MD-NEUROLOGY	4000 PALOS VERDES DR N	STE 104	ROLLING HILLS EST	CA	90274	2531	19	06037	33.78251876	-118.3524958	Los Angeles County
114815	Fee-for-Service	1316916778	1316916778	1	1	JING, TONG MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81645	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
114838	Fee-for-Service	1689945362	1689945362	1	1	JOHNSON, TYLER P MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114397	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114889	Fee-for-Service	1063836120	1063836120	1	1	JOSEPH, SHARY NP	5/9/2024	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
114915	Fee-for-Service	1235783895	1235783895	1	1	JENSEN, BROOKE D OT	8/9/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3889 W STETSON AVE	SUITE 150	HEMET	CA	92545	9686	33	06065	33.72930152	-117.011988	Riverside County
114951	Fee-for-Service	1578196416	1578196416	1	1	JEMERA, ERIC JAMES PT	5/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
114961	Fee-for-Service	1073647053	1073647053	1	1	JENKINS, ANNETTE A LMFT	5/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	229 S RIVERSIDE AVE	SUITE M	RIALTO	CA	92376	6467	36	06071	34.0977093	-117.3701818	San Bernardino County
114999	Fee-for-Service	1578662482	1578662482	1	1	JEANETTE M VINEY MD	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
115009	Fee-for-Service	1407341571	1407341571	1	1	JABBAR, TAHA MD	1/26/2022	207R00000X	NA	Other	026	PHYSICIANS	174852	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
115049	Fee-for-Service	1326029364	1326029364	1	1	JOHN MUELLER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY MEDICINE ASSOC	1625 NORTH GEORGE MASON	None	ARLINTON	VA	22205	0000	00	None	38.88895348	-77.12859872	Arlington
115053	Fee-for-Service	1497019103	1497019103	1	1	JULIAN UNION SCHOOL DISTRICT	7/1/2018	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1704 CAPE HORN	None	JULIAN	CA	92036	0000	37	06073	33.07703283	-116.5974387	San Diego County
115168	Fee-for-Service	1194567685	1194567685	1	1	JIN HEALING ACUPUNCTURE INC	6/7/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	TURE	1080 ALAMEDA DE LAS PULG	None	BELMONT	CA	94002	3508	41	06081	37.51028243	-122.2935479	San Mateo County
115339	Fee-for-Service	1447590567	1447590567	1	1	JONES, TRENETTA D LCSW	8/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	#100	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
115386	Fee-for-Service	1104877208	1104877208	1	1	JJ&R EMERGENCY MEDICAL	12/14/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GRP OF CALIFORNIA	18TH AVE & HWY 53	None	CLEARLAKE	CA	95422	0000	17	06033	38.936934	-122.6222415	Lake County
115448	Fee-for-Service	1598298325	1598298325	1	1	JANG, ALLYSON M MD	2/28/2025	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157144	09	Gynecology (D.O. only)	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
115466	Fee-for-Service	1588302665	1588302665	1	1	JIN, LAURA NP	9/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9817 ARKANSAS STREET	None	BELLFLOWER	CA	90706	5913	19	06037	33.87937427	-118.1245762	Los Angeles County
115521	Fee-for-Service	1134145394	1134145394	1	1	JERDEE, VALERIE C MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108427	40	Pediatrics	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
115564	Fee-for-Service	1376862177	1376862177	1	1	JOSHI, WEENA E MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91208	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
115612	Fee-for-Service	1134214679	1134214679	1	1	JUDGE, KANDEEL K MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51302	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
115731	Fee-for-Service	1427677707	1427677707	1	1	JOYNER, KYLE B MD	10/18/2023	207P00000X	NA	Other	026	PHYSICIANS	183774	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
115802	Fee-for-Service	1942411236	1942411236	1	1	JAMES R BRUNS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
115818	Fee-for-Service	1689987281	1689987281	1	1	JOHNSON, KIM M B PHD	12/30/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
115852	Fee-for-Service	1306882030	1306882030	1	1	JONES, SARAH S MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52847	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
115877	Fee-for-Service	1134193659	1134193659	1	1	JONES, DAVID MD	8/29/2023	207ZP0102X	NA	Other	026	PHYSICIANS	46543	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
115891	Fee-for-Service	1467608356	1467608356	1	1	JOHANSEN, NIPARPON V MFT	5/4/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2266 TORRANCE BLVD	SUITE 3	TORRANCE	CA	90501	2577	19	06037	33.8363745	-118.323243	Los Angeles County
115958	Fee-for-Service	1780610915	1780610915	1	1	JAMES WICKERATH M.D.	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 1ST AVE E	None	SPENCER	IA	51301	4342	00	None	43.14997136	-95.1438297	Clay County
116031	Fee-for-Service	1740338680	1740338680	1	1	JABLOW, BETTE L MD	6/11/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	12472	40	Pediatrics	0	In state provider	#101	1818 N ORANGE GROVE AVE	None	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
116072	Fee-for-Service	1265695795	1265695795	1	1	JUANG, PATRICIA S MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110217	67	Endocrinology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
116188	Fee-for-Service	1265446678	1265446678	1	1	JONES, AARON 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 W POPLAR ST	None	WALLA WALLA	WA	99362	2846	00	None	46.06269104	-118.3437284	Walla Walla County
116265	Fee-for-Service	1235362690	1235362690	1	1	JAGELS, LINDA T NP	2/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
116363	Fee-for-Service	1265695795	1265695795	1	1	JUANG, PATRICIA S MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110217	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
116373	Fee-for-Service	1174746606	1174746606	1	1	JOHN C FREMONT HEALTHCARE	4/13/2021	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
116384	Fee-for-Service	1821049032	1821049032	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC.	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
116503	Fee-for-Service	1750318002	1750318002	1	1	JENSEN, BRIAN T MD	2/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
116537	Fee-for-Service	1225439599	1225439599	1	1	JIMENEZ, ALMA L LMFT	6/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N. MACLAY AVE	109	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
116588	Fee-for-Service	1265510887	1265510887	1	1	JAYACHANDRAN, KAVITHA MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54455	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
116597	Fee-for-Service	1649757428	1649757428	1	1	J. B. PHYSICAL THERAPY INC.	10/22/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	212 GREEN VALLEY ROAD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
116663	Fee-for-Service	1174746606	1174746606	1	1	JOHN C FREMONT HEALTHCARE	12/1/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
116664	Fee-for-Service	1508177387	1508177387	1	1	JUAKIEM, WASSEM Y MD	7/1/2021	207R00000X	NA	Other	026	PHYSICIANS	172834	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116670	Fee-for-Service	1588982789	1588982789	1	1	JONES, SYBIL M. LCSW	8/23/2010	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	10630 TOWN CENTER DR.	SUITE 109	RANCHO CUCAMONGA	CA	91730	6806	36	06071	34.11112305	-117.5729644	San Bernardino County
116755	Fee-for-Service	1932681541	1932681541	1	1	JETSET DIETITIAN	2/4/2021	133V00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	50 ALESSANDRO PL	STE 360	PASADENA	CA	91105	3132	19	06037	34.13101049	-118.151532	Los Angeles County
116792	Fee-for-Service	1841367752	1841367752	1	1	JOSHI, BHERATKUMAR V MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30280	41	Internal Medicine	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
116810	Fee-for-Service	1780136820	1780136820	1	1	JOHNSON, KEENA CNP	12/1/2020	163WW0101X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16630 BROADWAY	None	GARDENA	CA	90248	2716	19	06037	33.87988966	-118.278108	Los Angeles County
116855	Fee-for-Service	1124322797	1124322797	1	1	JOHNSON, VIRGINIA M PHD	1/7/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
116862	Fee-for-Service	1841374840	1841374840	1	1	JONES, TRACEY A MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82542	25	Physical Medicine and Rehabilitation	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
116866	Fee-for-Service	1952567356	1952567356	1	1	JOY, BRIAN R LMFT	8/17/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	113211	-	NOT APPLICABLE	0	In state provider	None	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	31	06061	38.7303989	-121.2872592	Placer County
116949	Fee-for-Service	1174746606	1174746606	1	1	JOHN C FREMONT HEALTHCARE	12/1/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
116956	Fee-for-Service	1124017918	1124017918	1	1	JAMES B. LYONS M.D.	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
116957	Fee-for-Service	1538265830	1538265830	1	1	JAVADI, FARIBA MD	10/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97057	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
117032	Fee-for-Service	1265452593	1265452593	1	1	JOB, LEELA MD	12/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46301	01	General Practice	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
117106	Fee-for-Service	1164575411	1164575411	1	1	JOHN WILLIAM COLFORD M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
117145	Fee-for-Service	1619268463	1619268463	1	1	JIMENEZ, ANGELA C MD	5/2/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	115118	40	Pediatrics	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
117237	Fee-for-Service	1174746606	1174746606	1	1	JOHN C FREMONT HEALTHCARE	4/2/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
117244	Fee-for-Service	1982137212	1982137212	1	2	JAMAL, AMANDA L MD	11/10/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	159540	-	NOT APPLICABLE	0	In state provider	None	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
117371	Fee-for-Service	1407943863	1407943863	1	1	JOSLIN, JEANNE E LMFT	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3086 WEST RAMSEY ST	None	BANNING	CA	92220	3724	33	06065	33.92560089	-116.9101655	Riverside County
117422	Fee-for-Service	1528283348	1528283348	2	1	JUANA E VALDEZ	9/13/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9910 LONG BEACH BLVD	SUITE F	LYNWOOD	CA	90262	1561	19	06037	33.94501145	-118.2159621	Los Angeles County
117586	Fee-for-Service	1518041912	1518041912	1	1	JOHANNSEN, STEVEN P DC	11/29/2004	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	206 S MINER ST	None	WEAVERVILLE	CA	96093	0000	53	06105	40.73224284	-122.9416252	Trinity County
117607	Fee-for-Service	1043270226	1043270226	1	1	JAFARI-RASKE, GITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E OSBORN RD	None	SCOTTSDALE	AZ	85251	6432	00	None	33.488748	-111.9225285	Maricopa County
117629	Fee-for-Service	1497073910	1497073910	1	1	JEN, KUANG-YU MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103203	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
117658	Fee-for-Service	1013977537	1013977537	1	1	JAHN, KRISTEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
117752	Fee-for-Service	1063652162	1063652162	1	1	JOLLY, DESMOND A MD	7/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103143	40	Pediatrics	0	In state provider	None	865 THIRD AVE	#101	CHULA VISTA	CA	91911	1349	37	06073	32.62189562	-117.0722453	San Diego County
117759	Fee-for-Service	1629090220	1629090220	1	1	JOHNSTON, JON JAMES	1/31/1991	207P00000X	NA	Other	026	PHYSICIANS	4643	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
117790	Fee-for-Service	1962548644	1962548644	1	1	JIMENEZ, BELEN M	7/24/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
117980	Fee-for-Service	1720087877	1720087877	1	1	JOSHI, SUDHIR SHYAM MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67076	01	General Practice	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
118059	Fee-for-Service	1912033622	1912033622	1	1	JIMSHER MEDICAL GROUP	8/31/1993	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	8001 LAUREL CANYON BLVD	STE 109	NORTH HOLLYWOOD	CA	91605	1450	19	06037	34.216164	-118.396559	Los Angeles County
118146	Fee-for-Service	1457536088	1457536088	1	1	JAIN, RASHMI MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101933	41	Internal Medicine	0	In state provider	None	2255 YGNACIO VALLEY RD	STE N	WALNUT CREEK	CA	94598	3343	07	06013	37.92242643	-122.0301696	Contra Costa County
118162	Fee-for-Service	1093920084	1093920084	1	1	JOHNSON IV, XA D MD	8/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98000	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
118177	Fee-for-Service	1811037492	1811037492	1	1	JONBEC CARE, INC	12/1/1996	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CANAL DIVISION	11868 CANAL ST	None	GRAND TERRACE	CA	92313	4941	36	06071	34.03820541	-117.3185454	San Bernardino County
118242	Fee-for-Service	1164565917	1164565917	1	1	JUN, SUNNY H MD	9/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79883	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
118243	Fee-for-Service	1407983869	1407983869	1	1	JURA, YING H MD	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121238	34	Urology and Urological Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
118297	Fee-for-Service	1356494934	1356494934	1	1	JACKSON, SCOTT A	8/10/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	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
118431	Fee-for-Service	1881035814	1881035814	1	1	JENKINS, CHRISTINA N MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132205	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON	STE 421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
118527	Fee-for-Service	1972566503	1972566503	1	1	JOSEPH A HUDSON	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2010 BROOKWOOD MEDICAL C	None	BIRMINGHAM	AL	35209	6804	00	None	33.46310667	-86.77645664	Jefferson County
118541	Fee-for-Service	1134199649	1134199649	1	1	JOHNSON, ANDREW S MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52508	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
118573	Fee-for-Service	1760917835	1760917835	1	1	JOE, DANIEL K MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159720	None	None	0	In state provider	None	25828 REDLANDS BLVD	101	REDLANDS	CA	92373	8450	36	06071	34.06306846	-117.240957	San Bernardino County
118574	Fee-for-Service	1184736589	1184736589	1	1	JOSEPH, PAYMAN P MD APC	10/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	VAN NUYS WOMENS CARE MED	7232 VAN NUYS BLVD	STE 101	VAN NUYS	CA	91405	2231	19	06037	34.202241	-118.4487235	Los Angeles County
118585	Fee-for-Service	1598254195	1598254195	1	1	JEN, SABRINA P DO	11/8/2022	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	17646	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
118619	Fee-for-Service	1083662845	1083662845	1	1	JACKSON, CHARLES MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	35311	01	General Practice	0	In state provider	None	17122 BEACH BLVD	STE 102	HUNTINGTON BEACH	CA	92647	5992	30	06059	33.71348004	-117.9889448	Orange County
118631	Fee-for-Service	1730197609	1730197609	1	1	JOGANI, PIYUSH K MD	2/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	39138	41	Internal Medicine	0	In state provider	None	18250 ROSCOE BLVD	STE 310	NORTHRIDGE	CA	91325	4286	19	06037	34.22076142	-118.5313223	Los Angeles County
118665	Fee-for-Service	1013179399	1013179399	1	1	JUNG, DENISE W MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106651	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
118715	Fee-for-Service	1831444991	1831444991	1	1	JOYCE, KEVIN J	9/12/2012	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
118717	Fee-for-Service	1134655616	1134655616	1	1	JOHNSON, JOEANN CRNA	5/30/2019	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
118738	Fee-for-Service	1538397674	1538397674	1	1	JANNICKY, ELISABETH A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125831	None	None	0	In state provider	None	1145 W REDONDO BEACH	BLVD	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
118769	Fee-for-Service	1205841764	1205841764	1	1	JOSTE,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	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
118815	Fee-for-Service	1285032615	1285032615	1	1	JAIN, AARTI MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
118816	Fee-for-Service	1841001500	1841001500	1	1	JUSTIN CHING DO INC	2/24/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
118826	Fee-for-Service	1255950291	1255950291	1	1	JOHNSON, TRAVIS Z MD	7/14/2023	390200000X	NA	Other	026	PHYSICIANS	176755	None	None	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
118839	Fee-for-Service	1508326703	1508326703	1	1	JOHAL, RITIKA MD	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	182488	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
118919	Fee-for-Service	1730197609	1730197609	1	1	JOGANI, PIYUSH K MD	2/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	39138	10	Gastroenterology (M.D. only)	0	In state provider	None	18250 ROSCOE BLVD	STE 310	NORTHRIDGE	CA	91325	4286	19	06037	34.22076142	-118.5313223	Los Angeles County
118958	Fee-for-Service	1114656816	1114656816	1	1	JOURNEY HEALTH MEDICAL GROUP	11/14/2023	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA	2415 HIGH SCHOOL AVE	SUITE 700	CONCORD	CA	94520	1879	07	06013	37.98481374	-122.0347555	Contra Costa County
118993	Fee-for-Service	1396867867	1396867867	1	3	JOHNSON, ALEXANDRA A LCSW	3/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	640 W 20TH ST	None	SAN PEDRO	CA	90731	5520	19	06037	33.72607349	-118.2911715	Los Angeles County
119083	Fee-for-Service	1245492149	1245492149	1	1	JORGENSON, KJELL T MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101412	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
119153	Fee-for-Service	1124220231	1124220231	1	2	JOHNSON, JEREMIAH N MD	5/28/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	129261	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
119162	Fee-for-Service	1164619243	1164619243	1	1	JUDITH M AUSTIN	12/26/2004	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	74126 WINDFLOWER CT	None	PALM DESERT	CA	92261	2903	33	06065	33.78498948	-116.3717955	Riverside County
119182	Fee-for-Service	1487976387	1487976387	1	1	JACKSON, MARK H LCSW	4/21/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	106 POLLASKY AVE	SUITE D	CLOVIS	CA	93612	1159	10	06019	36.828954	-119.7020255	Fresno County
119243	Fee-for-Service	1114656816	1114656816	1	1	JOURNEY HEALTH MEDICAL GROUP	11/14/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	2415 HIGH SCHOOL AVE	SUITE 700	CONCORD	CA	94520	1879	07	06013	37.98481374	-122.0347555	Contra Costa County
119260	Fee-for-Service	1285644617	1285644617	1	1	JACOBSON, JERRY I	11/30/1986	207P00000X	NA	Other	026	PHYSICIANS	41921	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
119289	Fee-for-Service	1205832466	1205832466	1	1	JEFFREY GOLDSTEIN M.D.	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
119305	Fee-for-Service	1316337017	1316337017	1	1	JACOBSEN, DELYNN M LMFT	3/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 EAST AVENUE	SUITE 4B	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
119317	Fee-for-Service	1356423255	1356423255	1	1	JOSEPH, WILLIAM P MD	6/1/1982	207R00000X	NA	Other	026	PHYSICIANS	27536	41	Internal Medicine	0	In state provider	None	365 HAWTHORNE AVE	None	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
119393	Fee-for-Service	1891085361	1891085361	1	1	JEROME CORDOVA	10/13/2020	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
119423	Fee-for-Service	1639172331	1639172331	1	1	JOINT ACTIVE SYSTEMS INC	12/14/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	JOINT ACTIVE SYSTEMS INC	2600 S RANEY	None	EFFINGHAM	IL	62401	4219	00	None	39.09669944	-88.56143541	Effingham County
119465	Fee-for-Service	1770920639	1770920639	1	1	JAFRY, ZAN M MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141125	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
119480	Fee-for-Service	1396462313	1396462313	1	1	JURUPA VALLEY DOULAS,LLC	1/4/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
119568	Fee-for-Service	1710426267	1710426267	1	1	JUNG, ERIKA PHD	3/2/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
119720	Fee-for-Service	1942364427	1942364427	1	1	JOHNSON, SUSAN L MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83819	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
119786	Fee-for-Service	1346737491	1346737491	1	1	JAVED, AAMER MD	2/28/2025	207R00000X	NA	Other	026	PHYSICIANS	None	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
119929	Fee-for-Service	1396981478	1396981478	1	1	JESSICA F HUGHES KISICKI M.D	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	214 E 23RD ST	None	CHEYENNE	WY	82001	3748	00	None	41.1402124	-104.8159812	Laramie County
120010	Fee-for-Service	1306048624	1306048624	1	1	JUHN, OLIVIA T MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100002	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5 MEDICAL PLAZA DR	STE 250	ROSEVILLE	CA	95661	2868	31	06061	38.76604411	-121.2466761	Placer County
120150	Fee-for-Service	1184686073	1184686073	1	1	JOHNSON, ROBERT L	5/1/2022	207R00000X	NA	Other	026	PHYSICIANS	53221	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
120152	Fee-for-Service	1972681781	1972681781	1	1	JACOBS, STEPHEN E MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	39231	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
120251	Fee-for-Service	1518398775	1518398775	1	1	JOSEPH, ISABELLE NP	9/6/2024	363L00000X	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
120346	Fee-for-Service	1053535930	1053535930	1	1	JONATHAN PAUL PETERSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	15 SOUTH 1000 EAST	STE 200	PAYSON	UT	84651	1600	00	None	40.043646	-111.715901	Utah County
120429	Fee-for-Service	1477579472	1477579472	1	1	JEFFERS, GREGORY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37601	36	Psychiatry	0	In state provider	None	3131 BROWNS VALLEY RD	None	NAPA	CA	94558	5422	28	06055	38.30367773	-122.3214694	Napa County
120457	Fee-for-Service	1902982796	1902982796	1	1	JACKSON, WALTER O MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	70415	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	EMERGENCY DEPARTMENT	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
120506	Fee-for-Service	1497717912	1497717912	1	1	JENSEN, FAYE MD	2/19/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72068	09	Gynecology (D.O. only)	0	In state provider	None	105 MARGARET LN	STE A	GRASS VALLEY	CA	95945	5289	29	06057	39.22948777	-121.0465057	Nevada County
120544	Fee-for-Service	1215476916	1215476916	1	1	JENKINS, DAVID M	12/29/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
120551	Fee-for-Service	1255758314	1255758314	1	1	JARKA, CHRISTINE R LCSW	9/14/2018	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
120628	Fee-for-Service	1609187285	1609187285	1	1	JORGE, JENNIFER L MD	11/26/2018	207R00000X	NA	Other	026	PHYSICIANS	152970	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
120730	Fee-for-Service	1982643318	1982643318	1	1	JIMENEZ, JUAN C MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75166	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
120732	Fee-for-Service	1093730103	1093730103	1	1	JACKSON, STEPHEN H MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	12875	05	Anesthesiology	0	In state provider	INC	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
120784	Fee-for-Service	1235323619	1235323619	1	1	JAFFAR, AHSAN 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
120788	Fee-for-Service	1558460063	1558460063	1	1	JAHANGIR, RASHID MD	8/25/2014	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
120795	Fee-for-Service	1497717912	1497717912	1	1	JENSEN, FAYE MD	2/19/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72068	15	Obstetrics (D.O. only)	0	In state provider	None	105 MARGARET LN	STE A	GRASS VALLEY	CA	95945	5289	29	06057	39.22948777	-121.0465057	Nevada County
120989	Fee-for-Service	1407941818	1407941818	1	1	JUDD, DANIEL M OD	9/1/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 E HOBSONWAY	None	BLYTHE	CA	92225	1739	33	06065	33.61047531	-114.5900784	Riverside County
121067	Fee-for-Service	1801402151	1801402151	1	1	JONES, BONNIE B LCSW	10/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
121136	Fee-for-Service	1811170087	1811170087	1	1	JWCH INSTITUTE, INC	9/6/2005	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WEINGART MEDICAL CLINIC	515 E 6TH ST	None	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
121163	Fee-for-Service	1205892346	1205892346	1	1	JAMES, MICHELLE A MD	12/31/1988	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54828	None	None	0	In state provider	None	3838 CALIFORNIA ST	RM 111	SAN FRANCISCO	CA	94118	1504	38	06075	37.78591809	-122.4575439	San Francisco County
121208	Fee-for-Service	1861762452	1861762452	1	1	J & L GOLDMAN INC	6/29/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	20121 VENTURA BLVD	SUITE 210	WOODLAND HILLS	CA	91364	2545	19	06037	34.17068268	-118.5718406	Los Angeles County
121214	Fee-for-Service	1487870614	1487870614	1	1	JESSIE, MARQUIS L MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91999	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
121242	Fee-for-Service	1952407561	1952407561	1	1	JAHAN, JOHN MD	9/1/2000	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	52263	25	Physical Medicine and Rehabilitation	0	In state provider	None	1501 OCOTILLO DR	STE C	EL CENTRO	CA	92243	4217	13	06025	32.7771555	-115.570368	Imperial County
121306	Fee-for-Service	1013931930	1013931930	1	1	JUMA, SAAD MD	9/2/2020	208800000X	NA	Other	026	PHYSICIANS	42398	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
121425	Fee-for-Service	1023028446	1023028446	1	1	JACOBS, ROBERT D MD	4/25/1990	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	52767	84	Surgery-Head and Neck	0	In state provider	None	3907 WARING RD	STE 1A	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
121463	Fee-for-Service	1194711176	1194711176	1	1	JUSTICE, JAMES C MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71616	05	Anesthesiology	0	In state provider	None	313 E PLAZA DR	STE 12	SANTA MARIA	CA	93454	6931	42	06083	34.93744014	-120.4329079	Santa Barbara County
121466	Fee-for-Service	1609006592	1609006592	1	1	JACQUES, THOMAS J MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104289	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
121485	Fee-for-Service	1487687828	1487687828	1	1	JELINEK, MARYNELL MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58490	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
121644	Fee-for-Service	1396258851	1396258851	1	1	JASKIEWICZ, AMANDA C LMFT	6/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
121647	Fee-for-Service	1407945710	1407945710	1	1	JEFFREY WATABE	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	324 E 10TH AVE	STE 178	SALT LAKE CTY	UT	84103	2885	00	None	40.78074719	-111.8799317	Salt Lake County
121678	Fee-for-Service	1427251008	1427251008	1	1	JOHN JAY EVERETT MD	3/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 BARTLETT ST	None	HOMER	AK	99603	7005	00	None	59.65210843	-151.5501715	Kenai Peninsula Borough
121679	Fee-for-Service	1568881548	1568881548	1	1	JOSHI, NEHA S MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139431	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121703	Fee-for-Service	1992157317	1992157317	1	1	JAMES, EMILY OD	1/4/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	22247 MULHOLLAND HWY	None	CALABASAS	CA	91302	5156	19	06037	34.14755037	-118.6125002	Los Angeles County
121736	Fee-for-Service	1174793921	1174793921	1	1	JUAREZ, RICHARD E MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116409	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
121747	Fee-for-Service	1902003247	1902003247	1	1	JOSEPH ERBE	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
121775	Fee-for-Service	1003492323	1003492323	1	1	JB ARTHRITIS AND RHEUMATOLOG	11/1/2022	207RR0500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	Y CENTER	11480 BROOKSHIRE AVE	SUITE 108	DOWNEY	CA	90241	5020	19	06037	33.93622932	-118.1311752	Los Angeles County
121993	Fee-for-Service	1831123967	1831123967	1	1	JONES, HELMUTH G MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45850	20	Orthopedic Surgery	0	In state provider	None	6127 CLARK RD	None	PARADISE	CA	95969	4111	04	06007	39.76304842	-121.6042302	Butte County
122066	Fee-for-Service	1619210937	1619210937	1	1	JENKINS, TYLER G MD	7/18/2019	207ZC0006X	NA	Other	026	PHYSICIANS	135377	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
122089	Fee-for-Service	1336179662	1336179662	1	1	JODELE, SONATA MD	8/1/2017	2080P0207X	NA	Hematology	026	PHYSICIANS	75848	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
122162	Fee-for-Service	1669973129	1669973129	1	1	JACOBS, DESIREE B LCSW	7/30/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
122256	Fee-for-Service	1437611266	1437611266	1	1	JARRETT, TYLER R MD	8/23/2022	208M00000X	NA	Other	026	PHYSICIANS	179709	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
122408	Fee-for-Service	1659781391	1659781391	2	1	JANZ, HEATHER W LMFT	6/27/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6089 N 1ST ST	104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
122432	Fee-for-Service	1194884353	1194884353	1	1	JOHN KEVIN MAXWELL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 PROSPECT DR	None	GLENDIVE	MT	59330	0000	00	None	47.116899	-104.7042405	Dawson County
122531	Fee-for-Service	1962778704	1962778704	1	1	JOHNSON, MICHELLE L MD	2/26/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88868	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
122694	Fee-for-Service	1962445353	1962445353	1	1	JONES, 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	1170 CLEVELAND AVE	None	EAST POINT	GA	30344	3615	00	None	33.68127228	-84.42742435	Fulton County
122746	Fee-for-Service	1255891875	1255891875	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	37926 47TH ST E	None	PALMDALE	CA	93552	3272	19	06037	34.57140358	-118.0449908	Los Angeles County
122756	Fee-for-Service	1578640876	1578640876	1	1	JOSE FRANCISCO LUCIANO, 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	1530 9TH ST N	None	ST PETERSBURG	FL	33704	4202	00	None	27.78664382	-82.64678576	Pinellas County
122761	Fee-for-Service	1205310539	1205310539	1	1	JUJUN, SUYANTO RCP	11/8/2018	227900000X	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
122853	Fee-for-Service	1265850259	1265850259	1	1	JOHNSTON, DENNIS CO	1/11/2022	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3830 AUBURN BLVD.	A	SACRAMENTO	CA	95821	2136	34	06067	38.63979	-121.3748595	Sacramento County
122896	Fee-for-Service	1326482597	1326482597	1	1	JORDAN, JOSHUA L MD	12/1/2019	207R00000X	NA	Other	026	PHYSICIANS	162942	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
122925	Fee-for-Service	1891953790	1891953790	1	1	JACQUELINE MAHAL	4/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
123036	Fee-for-Service	1255891875	1255891875	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	37926 47TH ST E	None	PALMDALE	CA	93552	3272	19	06037	34.57140358	-118.0449908	Los Angeles County
123051	Fee-for-Service	1316058639	1316058639	1	1	JACOBSON, DOUGLAS W MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	102361	18	Ophthalmology	0	In state provider	None	200 S WELLS RD	STE 200	VENTURA	CA	93004	1377	56	06111	34.29321532	-119.1597424	Ventura County
123190	Fee-for-Service	1235120890	1235120890	1	1	JAYASINGHE, GAMINI S MD	6/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	26614	36	Psychiatry	0	In state provider	None	8522 TRAVISTUCK PL	None	BUENA PARK	CA	90621	1602	30	06059	33.88092314	-117.9846359	Orange County
123286	Fee-for-Service	1700958584	1700958584	2	1	JDUB PHARMA	7/2/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2611 E THOMPSON BLVD	STE 103	VENTURA	CA	93003	2743	56	06111	34.27266093	-119.2615945	Ventura County
123458	Fee-for-Service	1447484506	1447484506	1	1	JONES-GALANTE, JENNIFER A MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122065	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
123504	Fee-for-Service	1902350390	1902350390	1	1	JACOB, TANNA M	6/14/2022	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
123531	Fee-for-Service	1235536483	1235536483	1	1	JACKSON, EYVONNE	12/31/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	507 ELLIS STREET	None	LAKE ELSINORE	CA	92530	3828	33	06065	33.67528206	-117.3235418	Riverside County
123578	Fee-for-Service	1831726777	1831726777	1	1	JEON, ALBERT MD	10/1/2024	207L00000X	NA	Other	026	PHYSICIANS	188680	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
123735	Fee-for-Service	1003337411	1003337411	1	1	JIMENEZ, JANESSA L LMFT	7/31/2020	101YP2500X	NA	Other	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
123741	Fee-for-Service	1134879000	1134879000	1	1	JAIN, VANYA MD	11/22/2024	207R00000X	NA	Other	026	PHYSICIANS	187254	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
123808	Fee-for-Service	1336195759	1336195759	1	1	JOHN P EVERETT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
123818	Fee-for-Service	1235536483	1235536483	1	1	JACKSON, EYVONNE	12/31/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	507 ELLIS STREET	None	LAKE ELSINORE	CA	92530	3828	33	06065	33.67528206	-117.3235418	Riverside County
123930	Fee-for-Service	1386992543	1386992543	1	1	JULIA NHUNG PHAN YEUNG, O.D.	9/8/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	, PROFESSIONAL CORPORATI	1340 S. BEACH BLVD	None	LA HABRA	CA	90631	7475	30	06059	33.914655	-117.9662805	Orange County
123936	Fee-for-Service	1417926437	1417926437	2	1	JUMIG, ELMER A MD	1/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77244	40	Pediatrics	0	In state provider	None	2324 SANTA RITA RD	STE 12	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
123955	Fee-for-Service	1417037946	1417037946	1	2	JBJC INCORPORATED	12/26/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1640 WEST YOSEMITE AVE	SUITE 1	MANTECA	CA	95337	5192	39	06077	37.79729949	-121.243887	San Joaquin County
123998	Fee-for-Service	1255320198	1255320198	1	1	JAN A FAWCETT, 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
124002	Fee-for-Service	1194167205	1194167205	1	1	JENKINS, ANGELA M LCSW	11/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124089	Fee-for-Service	1477512960	1477512960	1	1	JAMES BRIAN WILLIAMS, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 N LEE AVE	None	OKLAHOMA CITY	OK	73102	1036	00	None	35.4780541	-97.52424339	Oklahoma County
124120	Fee-for-Service	1437489895	1437489895	1	1	JENNIFER L NORDQUIST, NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
124236	Fee-for-Service	1184602153	1184602153	1	1	JOHN, JAMIE S CRNA	12/20/2017	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
124245	Fee-for-Service	1417037946	1417037946	1	2	JBJC INCORPORATED	2/18/2022	261QP2000X	NA	Physical Therapist	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
124372	Fee-for-Service	1326276437	1326276437	1	1	JEANMENNE, ANTHONY R MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128253	30	Radiology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
124392	Fee-for-Service	1578094371	1578094371	1	1	JAKUBOWSKI, LAUREL K MD	9/15/2022	390200000X	NA	Other	026	PHYSICIANS	157039	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
124426	Fee-for-Service	1861832560	1861832560	1	1	JEN-MARTIN, ALEXANDRA M MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148343	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
124483	Fee-for-Service	1881805034	1881805034	1	1	JACKSON, MARNIE L MD	12/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
124512	Fee-for-Service	1710361092	1710361092	1	1	JOHNSON, NATALIE C MD	10/3/2018	208600000X	NA	General Surgery	026	PHYSICIANS	146567	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
124542	Fee-for-Service	1609069590	1609069590	1	1	JENG, SHYUN MD INC	10/1/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	53363	18	Ophthalmology	0	In state provider	None	4201 TORRANCE BLVD	SUITE 720	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
124701	Fee-for-Service	1922005859	1922005859	1	1	JONES, THOMAS A MD	11/30/1990	208800000X	NA	Other	026	PHYSICIANS	51735	34	Urology and Urological Surgery	0	In state provider	None	488 E VALLEY PKWY	STE 210	ESCONDIDO	CA	92025	3369	37	06073	33.12523814	-117.0769715	San Diego County
124727	Fee-for-Service	1770738122	1770738122	1	1	JOHNSON, CLAUDIUS LCSW	12/8/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	431 30TH STREET	SUITE 5	OAKLAND	CA	94609	3304	01	06001	37.81910206	-122.2653479	Alameda County
124825	Fee-for-Service	1477972156	1477972156	1	1	JONES, GREGORY S CRNA	4/5/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
124841	Fee-for-Service	1063828234	1063828234	1	1	JOSHUA TREE HEALTHCARE INC	8/1/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	391 N MAIN STREET	STE 307	CORONA	CA	92878	4001	33	06065	33.88547338	-117.5647471	Riverside County
124852	Fee-for-Service	1811004989	1811004989	1	1	JOHN CHANDLER KING, M.D.	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
124861	Fee-for-Service	1891718243	1891718243	1	1	JIANG, HUIYUAN MD	8/3/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	170408	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
124995	Fee-for-Service	1508131756	1508131756	1	1	JUNYA, SARA T MD	3/23/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164918	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
125077	Fee-for-Service	1629132857	1629132857	1	1	JOANNE VOGEL MD INC	12/24/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11030 BOLLINGER CANYON R	SUITE 250	SAN RAMON	CA	94582	4874	07	06013	37.77383963	-121.9239786	Contra Costa County
125167	Fee-for-Service	1649313362	1649313362	1	1	JOHNSON, KRISTEN H LCSW	9/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
125221	Fee-for-Service	1962625483	1962625483	1	1	JIAO, KUIRAN MD	9/4/2020	207L00000X	NA	Other	026	PHYSICIANS	132727	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
125242	Fee-for-Service	1114995297	1114995297	1	1	JULIE E TANK	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NORTHWEST RENTAL CLINIC	1015 NW 22ND AVE	None	PORTLAND	OR	97210	0000	00	None	45.53024175	-122.6966202	Multnomah County
125338	Fee-for-Service	1548493760	1548493760	1	1	JACOBSON, KRISTIN K PHD	4/17/2015	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
125421	Fee-for-Service	1215430319	1215430319	1	1	JEN, ANGELA PT	2/2/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
125442	Fee-for-Service	1790095040	1790095040	1	1	JAYASEKERA, CHANNA R MD	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113689	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
125519	Fee-for-Service	1639309909	1639309909	1	1	JONES-WOOD, JESSICA A LCSW	8/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	157 GRAND AVE	STE 208	PACIFIC GROVE	CA	93950	2752	27	06053	36.62198903	-121.9166381	Monterey County
125563	Fee-for-Service	1184917353	1184917353	1	1	JUTZY, GREGORY J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122156	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
125585	Fee-for-Service	1043582109	1043582109	1	1	JOHNSON, JENNIFER A MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127145	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
125599	Fee-for-Service	1851412894	1851412894	1	1	JIN MAN KIM FAMILY MD INC	3/27/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8237 ROCHESTER AVE	#130	RANCHO CUCAMONGA	CA	91730	6780	36	06071	34.103952	-117.5435325	San Bernardino County
125677	Fee-for-Service	1639532187	1639532187	1	1	JOO, JANICE MD	2/17/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	154893	None	None	0	In state provider	None	630 S RAYMOND AVE	STE 310	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
125731	Fee-for-Service	1790095040	1790095040	1	1	JAYASEKERA, CHANNA R MD	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113689	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125889	Fee-for-Service	1689800229	1689800229	1	1	JUNTILLA, MARISA M MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117810	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
126111	Fee-for-Service	1265408645	1265408645	1	1	JORGE, PHILLIP C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78921	05	Anesthesiology	0	In state provider	None	626 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.05442828	-118.2661966	Los Angeles County
126119	Fee-for-Service	1902113186	1902113186	1	1	JASON A. BLACK M.D., INC.	6/10/2019	261QP2300X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	24680 JEFFERSON AVE	STE A	MURRIETA	CA	92562	9023	33	06065	33.56056523	-117.2098454	Riverside County
126127	Fee-for-Service	1629431259	1629431259	1	1	JONES, ERIC MD	10/25/2021	207KA0200X	NA	Other	026	PHYSICIANS	152625	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
126188	Fee-for-Service	1558351577	1558351577	1	1	JOHN BOHNERT M.D.	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY ST	None	MISSOULA	MT	59802	4008	00	None	46.87419951	-114.0007525	Missoula County
126206	Fee-for-Service	1376740621	1376740621	1	1	JARAMILLA, RUSSELL C	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
126271	Fee-for-Service	1902373038	1902373038	1	1	JOHNSON, OFELIA LMFT	1/24/2024	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
126296	Fee-for-Service	1154762078	1154762078	1	1	JEFFREY SWICK	9/12/2018	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
126327	Fee-for-Service	1669498184	1669498184	1	1	JALALI-YAZDI, MARYAM MD	12/20/2005	174400000X	NA	Other	026	PHYSICIANS	54278	40	Pediatrics	0	In state provider	SALINAS VLLY PEDIA ASSOC	221 E ROMIE LN	None	SALINAS	CA	93901	3127	27	06053	36.66134721	-121.6520199	Monterey County
126347	Fee-for-Service	1972504793	1972504793	1	1	JENG, ANNIE C MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66990	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.0653985	-118.3769177	Los Angeles County
126353	Fee-for-Service	1578525044	1578525044	1	1	JUTZY, 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	925 HIGHLAND BLVD	STE 1180	BOZEMAN	MT	59715	6905	00	None	45.669618	-111.020184	Gallatin County
126368	Fee-for-Service	1689930851	1689930851	1	1	JOHNSON, ALISON L LMFT	2/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
126369	Fee-for-Service	1235535493	1235535493	1	1	JUNNIER, BRIAN C	12/4/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	THREE MEDICAL PLAZA	STE 120	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
126373	Fee-for-Service	1457815490	1457815490	1	1	JOYOUS HOME HEALTH CARE INC	12/16/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13363 SATICOY ST	STE 103A	NORTH HOLLYWOOD	CA	91605	3427	19	06037	34.2086537	-118.424562	Los Angeles County
126381	Fee-for-Service	1528564994	1528564994	1	1	JETTER, NATHAN F MD	11/7/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	180863	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
126408	Fee-for-Service	1093022196	1093022196	1	1	JAPRA, DEEPA MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136987	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
126453	Fee-for-Service	1982633004	1982633004	1	1	JHAVERI, NAMRATA D MD	6/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90313	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
126482	Fee-for-Service	1427518786	1427518786	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	45104 10TH ST W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
126528	Fee-for-Service	1578074035	1578074035	1	1	JIANG, YAN NP	1/6/2025	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
126532	Fee-for-Service	1518059229	1518059229	1	1	JOSSART, GREGG H MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75072	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
126552	Fee-for-Service	1235223314	1235223314	1	1	JENNINGS, JOE II MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48631	05	Anesthesiology	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
126610	Fee-for-Service	1679953004	1679953004	1	1	JUJUBE HOLDINGS, LLC	12/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1291 S BERNARDO AVE	None	SUNNYVALE	CA	94087	2060	43	06085	37.352952	-122.0596055	Santa Clara County
126743	Fee-for-Service	1427475805	1427475805	1	1	JAGANATH, DEVAN MD	7/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148357	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
126767	Fee-for-Service	1427518786	1427518786	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	45104 10TH ST W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
126802	Fee-for-Service	1396295994	1396295994	1	1	JUNG, KWANGMI K AC	4/3/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	520 N BROOKHURST ST	SUITE 102	ANAHEIM	CA	92801	8826	30	06059	33.838974	-117.959013	Orange County
126807	Fee-for-Service	1124374442	1124374442	1	1	JABARI, DUAA MD	6/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	183670	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
126847	Fee-for-Service	1366659294	1366659294	1	1	JAFFER, JIHAD MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	98822	25	Physical Medicine and Rehabilitation	0	In state provider	None	6010 HIDDEN VALLEY RD	STE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
126970	Fee-for-Service	1134394893	1134394893	1	1	JOEL HOLMAN M.D.	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	PO BOX 120	None	NEPHI	UT	84648	0120	00	None	0	0	None
127054	Fee-for-Service	1053624189	1053624189	1	1	JAIN, PRAGYA MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120149	41	Internal Medicine	0	In state provider	None	1199 BUSH ST	STE 400	SAN FRANCISCO	CA	94109	5945	38	06075	37.7891291	-122.4167087	San Francisco County
127094	Fee-for-Service	1588773402	1588773402	1	1	JAMES CHIA CHUNG MD APC	3/1/2000	207L00000X	NA	Other	026	PHYSICIANS	44296	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVENUE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
127104	Fee-for-Service	1558822734	1558822734	1	1	JAMISON, TAMMI LMFT	4/18/2024	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10940 FAIR OAKS BLVD STE	None	FAIR OAKS	CA	95628	5958	34	06067	38.650077	-121.263678	Sacramento County
127134	Fee-for-Service	1720272693	1720272693	1	1	JOHNSON, ADAM MD	6/8/2022	207L00000X	NA	Other	026	PHYSICIANS	90692	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
127149	Fee-for-Service	1033163985	1033163985	1	1	JEAN, MICHAEL C MD	11/12/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52532	10	Gastroenterology (M.D. only)	0	In state provider	None	23928 LYONS AVE	STE 206	NEWHALL	CA	91321	2409	19	06037	34.37895689	-118.5532505	Los Angeles County
127237	Fee-for-Service	1801874508	1801874508	1	1	JACOB, LUCY H OT	11/3/2019	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 NORTH COLLEGE DR	SUITE 203	SANTA MARIA	CA	93454	4614	42	06083	34.954461	-120.424836	Santa Barbara County
127300	Fee-for-Service	1336342237	1336342237	1	1	JANSEN, CHARLES A OD INC	12/16/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4000 TYLER ST	None	RIVERSIDE	CA	92503	3458	33	06065	33.91564903	-117.464488	Riverside County
127392	Fee-for-Service	1184931693	1184931693	1	1	JUDGE, ONKAR S MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114755	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
127433	Fee-for-Service	1093379299	1093379299	1	1	JUNG, YOONA MD	9/12/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	177556	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
127517	Fee-for-Service	1366733479	1366733479	1	1	JOSEPH PATTERSON	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 ST LUKES LN	None	STROUDSBURG	PA	18360	6217	00	None	40.99696005	-75.2589413	Monroe County
127541	Fee-for-Service	1992071229	1992071229	1	1	JOY, JENA J MD	11/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123214	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
127578	Fee-for-Service	1417031998	1417031998	1	1	JORGE, BERNARD S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33386	40	Pediatrics	0	In state provider	None	10001 CALIFORNIA AVE	None	SOUTH GATE	CA	90280	6005	19	06037	33.94353626	-118.207669	Los Angeles County
127581	Fee-for-Service	1144681388	1144681388	1	1	JONES, KAITLIN M	3/30/2016	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
127623	Fee-for-Service	1366734998	1366734998	1	1	JOHNSON, JEFFREY D MD	2/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172584	None	None	0	In state provider	None	1509 WILSON	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
127699	Fee-for-Service	1710929690	1710929690	1	1	JESUS SAENZ M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
127746	Fee-for-Service	1063596120	1063596120	1	1	JO,JENNIFER 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	1000 TRENT DRIVE	None	DURHAM	NC	27710	0000	00	None	36.00547588	-78.93519663	Durham County
127840	Fee-for-Service	1164514436	1164514436	1	1	JEREMY C LEWIS, 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	714 W PINE ST	None	NEWPORT	WA	99156	9046	00	None	48.1820733	-117.0490023	Pend Oreille County
127867	Fee-for-Service	1417031998	1417031998	1	1	JORGE, BERNARD S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33386	01	General Practice	0	In state provider	None	10001 CALIFORNIA AVE	None	SOUTH GATE	CA	90280	6005	19	06037	33.94353626	-118.207669	Los Angeles County
127916	Fee-for-Service	1063578227	1063578227	1	1	JAMES, ROBERT E III MD	12/24/1996	207ZP0105X	NA	Other	026	PHYSICIANS	40553	22	Pathology (M.D. only)	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
127926	Fee-for-Service	1407930001	1407930001	1	1	JESSICA SIU MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
127942	Fee-for-Service	1760825822	1760825822	1	1	JEFFREY HALLECK	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5212 S COTTONWOOD LN	None	MURRAY	UT	84117	7104	00	None	40.65797952	-111.826295	Salt Lake County
128036	Fee-for-Service	1144251075	1144251075	1	1	JEONG, MIKE Y DO	8/20/2015	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
128104	Fee-for-Service	1083636187	1083636187	1	1	JOTTERAND, VERONIQUE MD	9/24/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	54415	18	Ophthalmology	0	In state provider	None	2865 ATLANTIC AVE	STE 109	LONG BEACH	CA	90806	7404	19	06037	33.809418	-118.185058	Los Angeles County
128111	Fee-for-Service	1346398146	1346398146	1	1	JUNG, CHARLENE H MD	6/19/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83143	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
128214	Fee-for-Service	1326281023	1326281023	1	1	JAEGER, AMBER L MD	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125989	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100A DRAKES LANDING RD	SUITE 225	GREENBRAE	CA	94904	3119	21	06041	37.94379317	-122.5182162	Marin County
128311	Fee-for-Service	1386175263	1386175263	1	1	JAKHER, HAROON A MD	5/18/2020	207R00000X	NA	Other	026	PHYSICIANS	157040	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
128437	Fee-for-Service	1013403005	1013403005	1	1	JASWAL, TEJESHWER S DO	1/3/2024	207P00000X	NA	Other	026	PHYSICIANS	19448	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
128443	Fee-for-Service	1487720629	1487720629	1	1	JOHNSON, NANCY D LMFT	2/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
128466	Fee-for-Service	1730133208	1730133208	1	1	JEFFREY DINGMAN	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST ALPHONSUS RMC	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
128469	Fee-for-Service	1922064807	1922064807	1	1	JOHNSON, STEPHEN 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	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
128472	Fee-for-Service	1770917320	1770917320	1	1	JONES, KARYN E LCSW	3/3/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1370 VALLEY VISTA DR	SUITE 200	DIAMOND BAR	CA	91765	0000	19	06037	33.99742278	-117.8381087	Los Angeles County
128495	Fee-for-Service	1548348394	1548348394	1	1	JAFAR-ALI, SHUJA MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63991	36	Psychiatry	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
128509	Fee-for-Service	1366291775	1366291775	1	1	JIN, HAESU NP	8/7/2024	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
128674	Fee-for-Service	1497826309	1497826309	1	1	JIRAWUTHIWORAVONG, GUY V	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85177	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
128682	Fee-for-Service	1427491620	1427491620	1	1	JAJU, MINAL B MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
128734	Fee-for-Service	1215354162	1215354162	1	1	JJ ACU & HERB CLINIC	8/13/2018	305R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3680 WILSHIRE BLVD	STE 108	LOS ANGELES	CA	90010	2713	19	06037	34.06168854	-118.3062285	Los Angeles County
128779	Fee-for-Service	1598706103	1598706103	1	1	JOHN SHIMA	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	530 BOGACHIEL WAY	None	FORKS	WA	98331	9120	00	None	47.946141	-124.3931915	Clallam County
128842	Fee-for-Service	1588760979	1588760979	1	1	JONNALA, PRAVEEN MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88970	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
128933	Fee-for-Service	1871778886	1871778886	1	1	JAMES OOI MD APC	8/13/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	320 SOLANO ST	None	CORNING	CA	96021	3454	52	06103	39.92788753	-122.169861	Tehama County
128943	Fee-for-Service	1265483226	1265483226	1	1	JACOBS, SCOTT B MD	7/1/1991	207P00000X	NA	Other	026	PHYSICIANS	71885	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
128984	Fee-for-Service	1508201773	1508201773	1	1	JASON ANDERSON MD	4/18/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
129047	Fee-for-Service	1477602415	1477602415	1	1	JACOBSON, LARA M MD	10/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184994	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
129053	Fee-for-Service	1578962825	1578962825	1	1	JOHNSON, CRAIG R MD INC	4/6/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72241	None	None	0	In state provider	None	960 E GREEN ST	STE 292	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
129095	Fee-for-Service	1093889586	1093889586	1	1	JOHNSTONE, NOELLE V MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92087	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
129104	Fee-for-Service	1720201247	1720201247	1	1	JOHN C FREMONT HLTHCARE	12/1/1977	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
129129	Fee-for-Service	1588760979	1588760979	1	1	JONNALA, PRAVEEN MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88970	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
129169	Fee-for-Service	1437213972	1437213972	1	1	JEBRIL, ESTELA LCSW	10/27/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
129222	Fee-for-Service	1871778886	1871778886	1	1	JAMES OOI MD APC	8/13/1998	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	320 SOLANO ST	None	CORNING	CA	96021	3454	52	06103	39.92788753	-122.169861	Tehama County
129265	Fee-for-Service	1659319432	1659319432	1	1	JAINDL, JEFFREY J DO	11/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	12065	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
129343	Fee-for-Service	1457409328	1457409328	1	1	JANDHYALA, RAVI S MD	5/17/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51928	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
129384	Fee-for-Service	1417191958	1417191958	1	1	JIMENEZ, CLAUDIA 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
129386	Fee-for-Service	1558377523	1558377523	1	1	JAMAL, AAMIR Z MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51820	None	None	0	In state provider	None	315 N 3RD AVE	STE 207	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
129395	Fee-for-Service	1366057002	1366057002	1	1	JOVES, ARIEL NP	1/21/2021	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
129399	Fee-for-Service	1154811792	1154811792	1	1	JONES, ALEXIS C LCSW	3/24/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
129421	Fee-for-Service	1811130909	1811130909	1	1	JAHAN, SHARMIN MD	9/1/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	106346	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
129490	Fee-for-Service	1033767447	1033767447	1	1	JIANG, EUNICE PT	4/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
129511	Fee-for-Service	1366676330	1366676330	1	1	JEFFREY WALLHOFF 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	530 BOGACHIEL WAY	None	FORKS	WA	98331	9120	00	None	47.946141	-124.3931915	Clallam County
129512	Fee-for-Service	1871778886	1871778886	1	1	JAMES OOI MD APC	10/21/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	320 SOLANO ST	None	CORNING	CA	96021	3454	52	06103	39.92788753	-122.169861	Tehama County
129581	Fee-for-Service	1649560491	1649560491	1	1	JURICH, DANIEL B DO	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12757	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
129609	Fee-for-Service	1699720300	1699720300	1	1	JAVED, BADR S MD	7/19/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	158376	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
129812	Fee-for-Service	1932141900	1932141900	1	1	JON-PIERRE PAZEVIC DO	1/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6422	00	None	47.8799292	-122.2332137	Snohomish County
129845	Fee-for-Service	1366637175	1366637175	1	1	JABARI, ALI MD	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106532	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
129880	Fee-for-Service	1740783273	1740783273	1	1	JANEAN NOELANI GARCIA	1/24/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
129929	Fee-for-Service	1972523728	1972523728	1	1	JAZAYERI, AZAM MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48488	40	Pediatrics	0	In state provider	None	3831 HUGHES AVE	STE 502	CULVER CITY	CA	90232	6858	19	06037	34.02243278	-118.3981492	Los Angeles County
130044	Fee-for-Service	1326103771	1326103771	1	1	JAK, AMY J PHD	9/25/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130075	Fee-for-Service	1184389934	1184389934	1	1	JENSEN, ADRIENNE O NP	12/16/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130153	Fee-for-Service	1447569058	1447569058	1	1	JBL MED TRANSPORT	10/8/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	480 COLLINS AVE	UNIT C	COLMA	CA	94014	3208	41	06081	37.67337078	-122.4602406	San Mateo County
130180	Fee-for-Service	1144452152	1144452152	1	1	JIVRAJKA, RENU V MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113389	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
130196	Fee-for-Service	1831284249	1831284249	1	1	JACOBSON, MICHAEL B MD	3/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88422	40	Pediatrics	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
130277	Fee-for-Service	1093169963	1093169963	1	1	JEONG, AH-REUM MD	8/22/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	151010	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
130381	Fee-for-Service	1598830416	1598830416	1	1	JIA, RAN MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70416	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
130424	Fee-for-Service	1245478650	1245478650	1	1	JAMARI, GURLEEN S MD	9/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106286	41	Internal Medicine	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
130460	Fee-for-Service	1912169806	1912169806	1	1	JADE REED BRINGHURST M.D.	9/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1120	00	None	41.091012	-111.995523	Davis County
130474	Fee-for-Service	1720128473	1720128473	1	1	JOENSWHITE, TERI L LMFT	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17451 BASTANCHURY RD	STE 204-19	YORBA LINDA	CA	92886	1857	30	06059	33.89936219	-117.8306583	Orange County
130487	Fee-for-Service	1831284249	1831284249	1	1	JACOBSON, MICHAEL B MD	3/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88422	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
130706	Fee-for-Service	1164550877	1164550877	1	1	JIN, JOHN MD	5/3/2019	207L00000X	NA	Other	026	PHYSICIANS	159993	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
130760	Fee-for-Service	1205986718	1205986718	1	1	JONES, ABHILASHA S MD	11/4/2010	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
130779	Fee-for-Service	1902538580	1902538580	1	1	JACKSON-ZUCKERMAN INC	12/9/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TES	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
130856	Fee-for-Service	1417149527	1417149527	1	1	JANIE B MCJIMPSON	5/11/2007	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	40 QUIET HILLS RD	None	POMONA	CA	91766	4786	19	06037	34.02677372	-117.7668571	Los Angeles County
130939	Fee-for-Service	1336673490	1336673490	1	1	JIANG, SHARON Y MD	9/16/2022	207L00000X	NA	Other	026	PHYSICIANS	175908	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
130960	Fee-for-Service	1518321918	1518321918	1	1	JAREM, ERIN K DO	9/28/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	20085	None	None	0	In state provider	None	1140 W LA VETA AVE	STE 770	ORANGE	CA	98268	4225	30	06059	33.7802984	-117.8651669	Orange County
131047	Fee-for-Service	1467113506	1467113506	1	1	JONES, ERICA LCSW	7/7/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
131103	Fee-for-Service	1568955862	1568955862	1	1	JUAREZ, VICTORIA LCSW	9/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13075 BLACKBIRD ST	None	GARDEN GROVE	CA	92843	2902	30	06059	33.77353611	-117.9130729	Orange County
131185	Fee-for-Service	1477948800	1477948800	1	1	JAYADEVAN, RAJIV MD	2/24/2021	208800000X	NA	Other	026	PHYSICIANS	146043	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
131319	Fee-for-Service	1407300940	1407300940	1	1	JENKINS, JULIET A L MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144437	13	Neurology (M.D. only)	0	In state provider	None	2324 SACRAMENTO ST	STE 111	SAN FRANCISCO	CA	94115	2383	38	06075	37.79020149	-122.4313011	San Francisco County
131360	Fee-for-Service	1366655680	1366655680	1	1	JOSEPH, REENA MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103368	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
131381	Fee-for-Service	1699899757	1699899757	1	1	JONES, KELLY C LCSW	12/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14724 VENTURA BOULEVARD	SUITE 1100	SHERMAN OAKS	CA	91403	3511	19	06037	34.15179235	-118.4541787	Los Angeles County
131527	Fee-for-Service	1467654673	1467654673	1	1	JUERN, ANNA M MD	3/2/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	155156	07	Dermatology	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
131541	Fee-for-Service	1750893608	1750893608	1	1	JOHNSON, LAUREN J CRNA	2/5/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
131734	Fee-for-Service	1528251675	1528251675	1	1	JEFFREY J COWAN MD INC	12/10/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4201 TORRANCE	#600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
131811	Fee-for-Service	1770043176	1770043176	1	1	JACOBER, JOSHUA	10/13/2022	207P00000X	NA	Other	026	PHYSICIANS	181157	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
131975	Fee-for-Service	1801997051	1801997051	1	1	JACOBSEN, DONNA A DO	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9734	01	General Practice	0	In state provider	None	3466 MT DIABLO BLVD	STE C100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
132144	Fee-for-Service	1518295385	1518295385	1	1	JUDICE, SAMUEL L MD	1/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83028	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
132203	Fee-for-Service	1962446617	1962446617	1	1	JOSEPH TRACHY	11/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 PINE GROVE AVE	None	PORT HURON	MI	48060	3511	00	None	42.986844	-82.42983	St. Clair County
132263	Fee-for-Service	1285028407	1285028407	1	1	JOHNSON, KELLY A MD	6/12/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	146024	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
132276	Fee-for-Service	1710229133	1710229133	1	1	JENSEN, BJORN B MD	6/13/2018	207LP3000X	NA	Other	026	PHYSICIANS	134521	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
132377	Fee-for-Service	1295762714	1295762714	1	1	JAMIE GOGAL STRAUB D.O.	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6 13TH AVE E	None	POLSON	MT	59860	5315	00	None	47.682243	-114.1626375	Lake County
132383	Fee-for-Service	1750541363	1750541363	1	1	JOTHIKUMAR, PULIADI MD	12/3/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	30333	41	Internal Medicine	0	In state provider	None	1110 DELBON AVE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
132385	Fee-for-Service	1639264864	1639264864	1	1	JACKSON, CHRISTIAN S MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101156	None	None	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
132404	Fee-for-Service	1841711769	1841711769	1	1	JARY, JESSICA DO	10/4/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21723	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
132434	Fee-for-Service	1518295385	1518295385	1	1	JUDICE, SAMUEL L MD	1/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83028	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
132456	Fee-for-Service	1093223679	1093223679	1	1	JAMES, MOLLY A CCC-SLP	6/13/2022	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
132474	Fee-for-Service	1982623591	1982623591	1	1	JULIE TAN ANTIQUE	4/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
132487	Fee-for-Service	1295881787	1295881787	1	1	JENSEN, REINI A MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	81409	01	General Practice	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
132489	Fee-for-Service	1003847732	1003847732	1	1	JACQUES, CHERYL A	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5665 COLLEGE AVE	STE 320	OAKLAND	CA	94618	1625	01	06001	37.84429616	-122.2518174	Alameda County
132539	Fee-for-Service	1336488618	1336488618	1	1	JUSTIN WARREN REIF MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6468	00	None	47.8799292	-122.2332137	Snohomish County
132646	Fee-for-Service	1811926298	1811926298	1	1	JUAREZ, RICARDO H MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	59010	41	Internal Medicine	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
132648	Fee-for-Service	1689930844	1689930844	1	1	JACKSON, TAIJUANA A MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128405	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
132693	Fee-for-Service	1083899181	1083899181	1	1	JEW, JERRY Y MD	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93587	08	Family Practice	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
132704	Fee-for-Service	1649000589	1649000589	1	1	JACKSON, NEDRA LCSW	2/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
132866	Fee-for-Service	1750630125	1750630125	1	1	JAVVAJI, SRIMANASI MD	11/30/2018	207ND0101X	NA	Dermatology	026	PHYSICIANS	141780	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
132872	Fee-for-Service	1568449494	1568449494	1	1	JOHNSON, KEITH A MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87266	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
132875	Fee-for-Service	1285223552	1285223552	1	4	JIVA HEALTH, INC	4/25/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1145 WHISKEYTOWN CT	SUITE A	REDDING	CA	96001	0227	45	06089	40.58504488	-122.4126269	Shasta County
132940	Fee-for-Service	1639206527	1639206527	1	1	JACKSON, DONETTA LMFT	6/15/2022	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
132947	Fee-for-Service	1346435476	1346435476	1	1	JEON, INGA P MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	96231	01	General Practice	0	In state provider	None	710 N EUCLID ST	None	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
133004	Fee-for-Service	1225316581	1225316581	1	1	JACKSON, SHANA O LCSW	9/29/2024	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
133008	Fee-for-Service	1053305359	1053305359	1	1	JIN, JI-GUANG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74174	05	Anesthesiology	0	In state provider	None	10001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.76189202	-117.8348268	Orange County
133017	Fee-for-Service	1881803435	1881803435	1	1	JIMENEZ, ALLISON Y	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL 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
133121	Fee-for-Service	1811104144	1811104144	1	1	JOHNSON, JAMES A LCSW	4/6/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
133163	Fee-for-Service	1376615260	1376615260	1	1	JENNIFER SCHELER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
133170	Fee-for-Service	1588692479	1588692479	1	1	JOSEPH E LOVE MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
133185	Fee-for-Service	1821118910	1821118910	1	1	JHC CORPORATION	7/15/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4242 EL CAJON BLVD	None	SAN DIEGO	CA	92105	1230	37	06073	32.75523017	-117.1037018	San Diego County
133295	Fee-for-Service	1861549594	1861549594	1	1	JONES, EVALEEN K MD	2/28/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75962	08	Family Practice	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
133413	Fee-for-Service	1922197888	1922197888	1	1	JAMES GILBERT	3/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1440 N MAIN ST	None	SPEARFISH	SD	57783	1505	00	None	44.4981735	-103.8611443	Lawrence County
133472	Fee-for-Service	1679041172	1679041172	1	2	JONATHAN E THYGESON, M.D., I	7/19/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ADOLESCENT MEDICINE	6357 COYLE AVE	None	CARMICHAEL	CA	95608	0478	34	06067	38.668293	-121.3154865	Sacramento County
133493	Fee-for-Service	1881858751	1881858751	1	1	JENNISON, ERICA A PT	2/1/2018	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
133632	Fee-for-Service	1437139383	1437139383	1	1	JEFFREY R OLIVE MD	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 17TH AVE E	None	ALEXANDRIA	MN	56308	5273	00	None	45.87269049	-95.37631855	Douglas County
133645	Fee-for-Service	1447678743	1447678743	1	1	JOHNSON-KERNER, BETHANY MD	5/15/2019	390200000X	NA	Other	026	PHYSICIANS	143054	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
133656	Fee-for-Service	1720519200	1720519200	1	1	JIANG, AIYANG A MD	4/1/2022	390200000X	NA	Other	026	PHYSICIANS	159279	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
133657	Fee-for-Service	1700964871	1700964871	1	1	JAIN, ARUN MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	80467	18	Ophthalmology	0	In state provider	None	11911 ARTESIA BLVD	#102	CERRITOS	CA	90701	4065	19	06037	33.87314847	-118.079649	Los Angeles County
133666	Fee-for-Service	1982694162	1982694162	1	1	JOHN A. WILLIAMS, M.D.	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1758 PARK PL	STE 401	MONTGOMERY	AL	36106	1135	00	None	32.36859752	-86.28490562	Montgomery County
133742	Fee-for-Service	1306543996	1306543996	1	1	JOHNSON, ANISHA	10/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
133775	Fee-for-Service	1649355314	1649355314	1	1	JORDAN-MOORE, RA-CHEL MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	76134	18	Ophthalmology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
133776	Fee-for-Service	1649342445	1649342445	1	1	JOHNSTON, CLARISSA M MD	4/18/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62097	01	General Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
133786	Fee-for-Service	1043398852	1043398852	1	1	JOHNSON, CARL C MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
133795	Fee-for-Service	1700483443	1700483443	1	1	JAFAR, ALIYA N PT	2/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1100 N VENTURA RD	STE 103	OXNARD	CA	93030	3841	56	06111	34.212771	-119.1944035	Ventura County
133802	Fee-for-Service	1598829350	1598829350	1	10	JWCH INSTITUTE, INC	8/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3591 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2654	19	06037	33.93048952	-118.205541	Los Angeles County
133836	Fee-for-Service	1003041567	1003041567	1	1	JACKS, STEPHANIE MD	2/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165681	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
133967	Fee-for-Service	1497867428	1497867428	1	1	JAHANGIR HEKMAT, MARYAM J MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79051	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
134061	Fee-for-Service	1649342445	1649342445	1	1	JOHNSTON, CLARISSA M MD	4/18/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62097	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
134067	Fee-for-Service	1245060946	1245060946	1	1	JOSUE, JAIRYLE JAEN PT	11/15/2024	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
134072	Fee-for-Service	1124186101	1124186101	1	1	JANISKI, CARRIE R DO	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14188	01	General Practice	0	In state provider	None	830 SCENIC DRIVE	STE B	MODESTO	CA	95350	6133	50	06099	37.64720049	-120.982338	Stanislaus County
134090	Fee-for-Service	1598829350	1598829350	1	10	JWCH INSTITUTE, INC	8/14/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3591 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2654	19	06037	33.93048952	-118.205541	Los Angeles County
134102	Fee-for-Service	1295883635	1295883635	1	1	JANES, CHARLES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	21690	18	Ophthalmology	0	In state provider	None	420 E 3RD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
134123	Fee-for-Service	1003041567	1003041567	1	1	JACKS, STEPHANIE MD	2/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165681	40	Pediatrics	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
134211	Fee-for-Service	1902047814	1902047814	1	2	JOLLY, SHASHANK MD	4/3/2018	208600000X	NA	General Surgery	026	PHYSICIANS	126261	33	Thoracic Surgery	0	In state provider	None	2333 MOWRY AVE	# 300	FREMONT	CA	94538	1626	01	06001	37.55614438	-121.9822469	Alameda County
134241	Fee-for-Service	1861612327	1861612327	1	1	JEWISH FAM SERVICE OF LA	3/10/2006	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	SUITE 700	LOS ANGELES	CA	90010	2510	19	06037	34.06170677	-118.302787	Los Angeles County
134274	Fee-for-Service	1306224662	1306224662	1	1	J & R PHARMACY P C	2/3/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 MAGNOLIA AVE	UNIT 1-G	CORONA	CA	92879	3120	33	06065	33.85936872	-117.5534605	Riverside County
134284	Fee-for-Service	1578958757	1578958757	1	1	JABER, YASMEEN M MD	7/2/2020	208800000X	NA	Other	026	PHYSICIANS	168719	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
134380	Fee-for-Service	1598829350	1598829350	1	10	JWCH INSTITUTE, INC	8/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3591 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2654	19	06037	33.93048952	-118.205541	Los Angeles County
134391	Fee-for-Service	1295883635	1295883635	1	1	JANES, CHARLES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	21690	02	General Surgery	0	In state provider	None	420 E 3RD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
134449	Fee-for-Service	1851677090	1851677090	1	1	JOHNSON, JAIME N CRNA	6/3/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
134564	Fee-for-Service	1558651539	1558651539	1	1	JAMSHIDI, ALI O MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150112	14	Neurological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134606	Fee-for-Service	1841223617	1841223617	1	1	JAMIESON, CATRIONA H MD	4/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67419	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
134646	Fee-for-Service	1598829350	1598829350	1	3	JWCH INSTITUTE, INC	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1670 E 120TH ST	W SUPPORT BLDG 14 FL 2	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
134697	Fee-for-Service	1346543139	1346543139	1	1	JACKSON, CHRISTOPHER LMFT	3/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
134708	Fee-for-Service	1528558160	1528558160	1	1	JEON, CALEB MD	11/6/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	163750	07	Dermatology	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
134778	Fee-for-Service	1659426922	1659426922	1	1	JAIN, VINITA V MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72810	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	SUITE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
134840	Fee-for-Service	1568738102	1568738102	1	1	JOSHI, NIKHIL V MD	7/10/2020	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	141446	09	Gynecology (D.O. only)	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
134934	Fee-for-Service	1598829350	1598829350	1	3	JWCH INSTITUTE, INC	11/21/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1670 E 120TH ST	W SUPPORT BLDG 14 FL 2	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
134973	Fee-for-Service	1588851950	1588851950	1	1	JENNIFER LONGO 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	501 6TH AVE S	None	ST PETERSBURG	FL	33701	4634	00	None	27.76427551	-82.640637	Pinellas County
135003	Fee-for-Service	1699871244	1699871244	1	1	JENKINS, SHEILA D MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60512	79	Neurology-Child	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
135071	Fee-for-Service	1992093173	1992093173	1	1	JOSHI, RAJ R MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144175	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
135128	Fee-for-Service	1306084272	1306084272	1	2	JAIME ELIZABETH MEDVENE PHD	6/19/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	A PROFESSIONAL PSYCHOLOG	30200 AGOURA RD	SUITE 190	AGOURA HILLS	CA	91301	5434	19	06037	34.14513267	-118.7821377	Los Angeles County
135161	Fee-for-Service	1982960449	1982960449	1	1	JANIK, ADAM C MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143854	01	General Practice	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
135185	Fee-for-Service	1689775512	1689775512	1	1	JAGANATH, MYTHILI LMFT	6/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	STE 307	CANOGA PARK	CA	91303	3011	19	06037	34.20099048	-118.60776	Los Angeles County
135212	Fee-for-Service	1194063529	1194063529	1	1	JONATHAN NASSERI MD CORP	4/12/2019	207R00000X	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
135237	Fee-for-Service	1457705758	1457705758	1	1	JOHL, SHARANDEEP K NP	5/18/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4120 DALE RD	J8-140	MODESTO	CA	95356	9232	50	06099	37.69845549	-121.0499944	Stanislaus County
135289	Fee-for-Service	1801907225	1801907225	1	1	JOHNSON, MELISSA R MD	1/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55467	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
135369	Fee-for-Service	1568502839	1568502839	1	1	JACKLER, ROBERT K MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	43573	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
135419	Fee-for-Service	1255490975	1255490975	1	1	JONES, KARMEN M CNM	2/27/2009	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0725	36	06071	34.5406159	-117.2658221	San Bernardino County
135449	Fee-for-Service	1982960449	1982960449	1	1	JANIK, ADAM C MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143854	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
135521	Fee-for-Service	1083053342	1083053342	1	1	JAGUR, PARMINDER P DPM	9/3/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3031 W MARCH LANE	STE 310	STOCKTON	CA	95219	6562	39	06077	37.9842796	-121.3494311	San Joaquin County
135537	Fee-for-Service	1629006887	1629006887	1	1	JOSEPH PATRICK HART, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
135559	Fee-for-Service	1467608745	1467608745	1	1	JANUS OF SANTA CRUZ	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	200 7TH AVENUE	None	SANTA CRUZ	CA	95062	4669	44	06087	36.96438797	-121.998448	Santa Cruz County
135644	Fee-for-Service	1841330420	1841330420	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	AARON HOUSE	1010 AARON DR	None	REDLANDS	CA	92374	3815	36	06071	34.0659	-117.154473	San Bernardino County
135697	Fee-for-Service	1386141711	1386141711	1	1	JULIAN, JONATHAN A LMFT	7/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
135701	Fee-for-Service	1154753655	1154753655	1	1	JONES, ISIS J PSYD	7/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
135719	Fee-for-Service	1316097173	1316097173	1	1	JAMMALAMADAKA, KAMESWARI	12/26/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3700 DELTA FAIR BLVD	SUITE 201A	ANTIOCH	CA	94509	4007	07	06013	38.0038852	-121.8448833	Contra Costa County
135738	Fee-for-Service	1922578814	1922578814	1	1	JONG-DELGADO, MARISSA PT	5/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
135831	Fee-for-Service	1558099408	1558099408	1	1	JASSO, EDUARDO LCSW	6/14/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
135948	Fee-for-Service	1730159757	1730159757	1	1	JACOBSEN, NANCY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75268	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
135977	Fee-for-Service	1528027497	1528027497	1	1	JONOKUCHI, CARL K MD	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52095	01	General Practice	0	In state provider	None	243 MARCH STREET	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
135984	Fee-for-Service	1821017443	1821017443	1	1	JENSEN, DENNIS M MD	1/30/1997	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	28332	None	None	0	In state provider	None	10833 LE CONTE AVE	BLDG 32	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
135999	Fee-for-Service	1043385271	1043385271	1	1	JACKSON, ROLAND I JR	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
136063	Fee-for-Service	1992299978	1992299978	1	1	JUNUS, JUSTIN L DO	5/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20581	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
136067	Fee-for-Service	1730237058	1730237058	1	1	JULKA, DILPREET P MD AMC	4/16/2008	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	55266	45	Nephrology (Renal-Kidney)	0	In state provider	None	1700 E CESAR E CHAVEZ	STE 3800	LOS ANGELES	CA	90033	2450	19	06037	34.05101259	-118.217259	Los Angeles County
136127	Fee-for-Service	1447792171	1447792171	1	1	JIANG, JUN Y MD	1/13/2022	207R00000X	NA	Other	026	PHYSICIANS	164182	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
136146	Fee-for-Service	1508808890	1508808890	1	1	JOANNE J PENTOPOULOS MD	5/23/2013	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
136154	Fee-for-Service	1699729640	1699729640	1	1	JACKSON, REBECCA A MD	5/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55870	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
136169	Fee-for-Service	1801959143	1801959143	1	1	JOHNS, NICOLE J LMFT	4/4/2022	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
136180	Fee-for-Service	1891766036	1891766036	1	1	JANET M SWEETMAN 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	3033 S PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
136214	Fee-for-Service	1740280932	1740280932	1	1	JAMAL, HYDER Z MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63346	10	Gastroenterology (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	STE 704	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
136358	Fee-for-Service	1366474868	1366474868	1	1	JURMAIN, RICHARD B MD	1/1/1976	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22905	None	None	0	In state provider	None	3831 HUGHES AVE	STE 604	CULVER CITY	CA	90232	6804	19	06037	34.02243278	-118.3981492	Los Angeles County
136361	Fee-for-Service	1730237058	1730237058	1	1	JULKA, DILPREET P MD AMC	4/16/2008	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	55266	41	Internal Medicine	0	In state provider	None	1700 E CESAR E CHAVEZ	STE 3800	LOS ANGELES	CA	90033	2450	19	06037	34.05101259	-118.217259	Los Angeles County
136379	Fee-for-Service	1760630685	1760630685	1	1	JONES, KEITH M MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146651	02	General Surgery	0	In state provider	None	6555 COYLE AVE	STE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
136391	Fee-for-Service	1407808058	1407808058	1	2	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1845 N FAIR OAKS AVE	STE G151	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
136398	Fee-for-Service	1578873592	1578873592	1	1	JACKSON MEDICAL SUPPLY INC	5/5/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	480 REDWOOD ST	STE 34	VALLEJO	CA	94590	2958	48	06095	38.12315545	-122.2597619	Solano County
136404	Fee-for-Service	1568051019	1568051019	1	1	JOHNSTON, LAUREN OT	9/24/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
136428	Fee-for-Service	1184736589	1184736589	2	1	JOSEPH, PAYMAN P MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7232 VAN NUYS BLVD	STE 101	VAN NUYS	CA	91405	2231	19	06037	34.202241	-118.4487235	Los Angeles County
136467	Fee-for-Service	1629165329	1629165329	1	1	JUSTIZ, PATRICK J MD	4/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63347	01	General Practice	0	In state provider	None	14901 RINALDI ST	STE #200	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
136485	Fee-for-Service	1770099814	1770099814	1	1	JACOBSON, JEDIDIAH A CPO	8/28/2018	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7910 FROST ST	STE 320	SAN DIEGO	CA	92123	2791	37	06073	32.80027449	-117.153846	San Diego County
136508	Fee-for-Service	1245237445	1245237445	1	1	JENNINGS-NUNEZ, C D MD	4/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61723	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVE	STE 200	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
136580	Fee-for-Service	1609177641	1609177641	1	1	JENKINS, CHARLOTTE NP	6/24/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3333 CONCOURS	4200	ONTARIO	CA	91764	6547	36	06071	34.0749	-117.5787495	San Bernardino County
136625	Fee-for-Service	1295711224	1295711224	1	1	JOSEPH MEDICAL GROUP INC	4/1/2000	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6261 STANTON AVENUE	None	BUENA PARK	CA	90621	2436	30	06059	33.86943847	-117.9938846	Orange County
136677	Fee-for-Service	1407808058	1407808058	1	2	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1845 N FAIR OAKS AVE	STE G151	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
136760	Fee-for-Service	1336196039	1336196039	1	1	JACOBSON MEMORIAL HOSPITAL	10/17/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 EAST ST N	None	ELGIN	ND	58533	7105	00	None	46.40485828	-101.8423608	Grant County
136773	Fee-for-Service	1366536328	1366536328	2	1	JACKSON, PETER J MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	46502	40	Pediatrics	0	In state provider	None	13711 VAN NUYS BLVD	STE 1 & 2	PACOIMA	CA	91331	3638	19	06037	34.25923536	-118.4315636	Los Angeles County
136791	Fee-for-Service	1154352870	1154352870	1	1	JOSEPHSON, LISA D MD	6/1/1998	207P00000X	NA	Other	026	PHYSICIANS	72975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 CITY DR S	BLDG 1	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
136807	Fee-for-Service	1417904020	1417904020	1	1	JAWIEN, WILLIAM MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74904	78	Neoplastic Diseases/Oncology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
136812	Fee-for-Service	1376693184	1376693184	1	1	JOSEPH, PHILIP M MD	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87012	08	Family Practice	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
136820	Fee-for-Service	1700171220	1700171220	1	1	JOHNSON, ARI D MD	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124410	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
136854	Fee-for-Service	1962588087	1962588087	1	1	JAIN, PRIYANKA MD	1/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94262	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
136864	Fee-for-Service	1790265650	1790265650	1	1	JUAN CORNELL	10/25/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1622 PALERMO DR	None	RIVERSIDE	CA	92507	0200	33	06065	33.99709391	-117.3522102	Riverside County
136878	Fee-for-Service	1699865584	1699865584	1	1	JOHNSTON, BRIAN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LINDA D.	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
136907	Fee-for-Service	1801362611	1801362611	1	1	JACKSON, TAMIKA L 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
136912	Fee-for-Service	1295711224	1295711224	1	1	JOSEPH MEDICAL GROUP INC	4/1/2000	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	6261 STANTON AVENUE	None	BUENA PARK	CA	90621	2436	30	06059	33.86943847	-117.9938846	Orange County
136936	Fee-for-Service	1073088720	1073088720	1	1	JMDK HEALTHCARE LLC	6/1/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	337 NORTH VINEYARD AVE	SUITE 400	ONTARIO	CA	91764	4436	36	06071	34.066728	-117.611622	San Bernardino County
136958	Fee-for-Service	1609646306	1609646306	1	1	JULIAN, MEAGAN AU	3/1/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
137094	Fee-for-Service	1417904020	1417904020	1	1	JAWIEN, WILLIAM MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74904	68	Hematology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
137166	Fee-for-Service	1952538993	1952538993	1	1	JUCKSCH, CHERYL NP	4/16/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	37	06073	32.82010691	-117.1788026	San Diego County
137199	Fee-for-Service	1295711224	1295711224	1	1	JOSEPH MEDICAL GROUP INC	4/1/2000	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	6261 STANTON AVENUE	None	BUENA PARK	CA	90621	2436	30	06059	33.86943847	-117.9938846	Orange County
137225	Fee-for-Service	1073088720	1073088720	1	1	JMDK HEALTHCARE LLC	6/1/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	337 NORTH VINEYARD AVE	SUITE 400	ONTARIO	CA	91764	4436	36	06071	34.066728	-117.611622	San Bernardino County
137227	Fee-for-Service	1487876306	1487876306	1	1	JINES, N P MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72898	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137237	Fee-for-Service	1952838930	1952838930	1	1	JAIN, NISHITA MD	7/2/2020	207R00000X	NA	Other	026	PHYSICIANS	161321	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
137338	Fee-for-Service	1497978597	1497978597	1	1	JOHNSON, PRAMITA LMFT	7/1/2019	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
137365	Fee-for-Service	1811023526	1811023526	1	1	JAHANSOUZ, ROUZBEH MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102428	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
137398	Fee-for-Service	1407832140	1407832140	1	1	JACK KADEMIAN MD	6/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
137409	Fee-for-Service	1528097847	1528097847	1	1	JOHNSTON, TIMOTHY S MD	9/22/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58698	None	None	0	In state provider	None	1289 D ST	None	MERCED	CA	95340	6247	24	06047	37.29248985	-120.474035	Merced County
137454	Fee-for-Service	1467530550	1467530550	1	1	JENKINS, PHILIP N MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77791	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
137465	Fee-for-Service	1225307580	1225307580	1	1	JAIN, ABHI DO	4/14/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22530	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137493	Fee-for-Service	1508856386	1508856386	1	1	JIO, STEVEN S OD	9/5/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2098 9TH ST	None	LOS OSOS	CA	93402	3239	40	06079	35.3133519	-120.8332767	San Luis Obispo County
137522	Fee-for-Service	1083728190	1083728190	1	2	JOHNSON-CHAVIS, TONI D	7/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	32796	None	None	0	In state provider	MD INC	11868 ROSECRANS AVE	None	NORWALK	CA	90650	3081	19	06037	33.90212153	-118.080252	Los Angeles County
137569	Fee-for-Service	1629134259	1629134259	1	1	JUHA, GWENDOLYN M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
137614	Fee-for-Service	1043902141	1043902141	1	1	JANZAD, MARIAM NP	1/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1104 BUCHANAN RD	SUITE B5	ANTIOCH	CA	94509	4205	07	06013	37.99867244	-121.823243	Contra Costa County
137670	Fee-for-Service	1194791772	1194791772	1	1	JUNG, TYLER S MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50323	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
137863	Fee-for-Service	1821863986	1821863986	1	2	JEAN G. TRAN, MD, PC	6/27/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	13031 KERRY ST	None	GARDEN GROVE	CA	92844	1638	30	06059	33.773265	-117.958877	Orange County
137870	Fee-for-Service	1689854986	1689854986	1	1	JAHANGIRI, GREGORY B DO	2/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	5721	01	General Practice	0	In state provider	None	3004 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1637	19	06037	34.03050638	-118.2071956	Los Angeles County
137912	Fee-for-Service	1609883438	1609883438	1	1	JACKSON, BRUCE K MD	5/8/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	24716	41	Internal Medicine	0	In state provider	None	5445 INSPIRATION DR	None	RIVERSIDE	CA	92506	3434	33	06065	33.95236732	-117.3614584	Riverside County
137915	Fee-for-Service	1922367473	1922367473	1	1	JAIN, CHANDRA M MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149966	01	General Practice	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
137932	Fee-for-Service	1326356627	1326356627	1	1	JOHNSON, MARSHA Y LMFT	2/26/2019	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
137958	Fee-for-Service	1194791772	1194791772	1	1	JUNG, TYLER S MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50323	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
137981	Fee-for-Service	1568487973	1568487973	1	1	JOHNSON, ROY R MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34973	08	Family Practice	0	In state provider	P O BOX 348	28743 VALLEY CENTER RD	None	VALLEY CENTER	CA	92082	6530	37	06073	33.23089256	-117.0333217	San Diego County
137985	Fee-for-Service	1013065085	1013065085	1	1	JOHN, SUNGJIN MD	10/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87011	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
137993	Fee-for-Service	1497779425	1497779425	1	1	JACOBS, BRIAN P LCSW	9/25/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	868 GRAVENSTEIN HWY N	None	SEBASTOPOL	CA	95472	2810	49	06097	38.40946337	-122.8405126	Sonoma County
138000	Fee-for-Service	1275599052	1275599052	1	1	JACINTHO, AKO A MD	8/27/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	70786	-	NOT APPLICABLE	0	In state provider	None	145 WEST 22ND ST	1ST FLOOR	LOS ANGELES	CA	90007	1405	19	06037	34.0290608	-118.2680191	Los Angeles County
138003	Fee-for-Service	1356608319	1356608319	1	1	JOU, PAUL C MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148966	07	Dermatology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
138084	Fee-for-Service	1154611762	1154611762	1	1	JACOB, NIDHI S MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116501	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
138104	Fee-for-Service	1306402177	1306402177	1	1	JOSHI, DEVKI MD	7/31/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187416	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
138140	Fee-for-Service	1669474458	1669474458	1	1	JOSHI, TARLA MD	10/1/1983	207RN0300X	NA	Nephrology	026	PHYSICIANS	37549	01	General Practice	0	In state provider	None	2505 SAMARITAN DR	STE 308	SAN JOSE	CA	95124	4010	43	06085	37.25111447	-121.9483395	Santa Clara County
138210	Fee-for-Service	1922367473	1922367473	1	1	JAIN, CHANDRA M MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149966	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
138246	Fee-for-Service	1194791772	1194791772	1	1	JUNG, TYLER S MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50323	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
138249	Fee-for-Service	1659924488	1659924488	1	1	JASPREET S AHUJA MD INC	10/21/2019	207RC0200X	NA	Other	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
138259	Fee-for-Service	1255875431	1255875431	1	1	JRD PHYSICAL THERAPY INC	1/4/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4220 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	3511	30	06059	33.8029437	-118.059982	Orange County
138271	Fee-for-Service	1447397120	1447397120	1	1	JONBEC CARE, INC	12/1/1996	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MAVIS DIVISION	22130 MAVIS ST	None	GRAND TERRACE	CA	92313	5611	36	06071	34.02848424	-117.3217255	San Bernardino County
138304	Fee-for-Service	1235352220	1235352220	1	1	JACKSON, RHONETTE E MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80369	40	Pediatrics	0	In state provider	None	8120 TIMBERLAKE WAY	STE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
138305	Fee-for-Service	1942582390	1942582390	1	1	JABBOUR, MONIQUE CRNA	10/10/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
138370	Fee-for-Service	1669672523	1669672523	1	1	JENNIFER L LIU	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
138515	Fee-for-Service	1689650640	1689650640	1	1	JACOBS, KENT 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	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
138540	Fee-for-Service	1659924488	1659924488	1	1	JASPREET S AHUJA MD INC	10/21/2019	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
138570	Fee-for-Service	1447294715	1447294715	1	1	JAVAHERIAN, JASMIN DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8083	41	Internal Medicine	0	In state provider	None	16661 VENTURA BLVD	STE 815	ENCINO	CA	91436	1996	19	06037	34.15820737	-118.496492	Los Angeles County
138646	Fee-for-Service	1629556501	1629556501	1	1	JORDAN MANZANO, CARLOS MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	106140	36	Psychiatry	0	In state provider	INC	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
138750	Fee-for-Service	1851322028	1851322028	1	1	JEFFREY L MANSOOR MD INC	1/16/2018	208VP0000X	NA	Other	026	PHYSICIANS	None	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
138892	Fee-for-Service	1164789459	1164789459	1	2	JOSEPH MOZA, MD, INC	2/14/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	74361 HIGHWAY 111	STE. 5	PALM DESERT	CA	92260	4124	33	06065	33.7210535	-116.3673675	Riverside County
138937	Fee-for-Service	1588249080	1588249080	1	1	JOHN M FEJES MD INC	5/9/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2 UPPER RAGSDALE DR	STE B280	MONTEREY	CA	93940	7846	27	06053	36.57940327	-121.8142876	Monterey County
138940	Fee-for-Service	1265466866	1265466866	1	1	JOHNSON, KURT D MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50605	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
139037	Fee-for-Service	1366462939	1366462939	1	1	JACOBS, EDWIN L MD	9/30/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	62813	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
139081	Fee-for-Service	1689725566	1689725566	1	1	JUN, ANGELA H NP	8/10/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
139093	Fee-for-Service	1184825986	1184825986	1	1	JOVANOVIC, VUK MD	11/8/2019	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	112405	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
139124	Fee-for-Service	1407401128	1407401128	1	1	JULIAN, FIDES Q LAC	2/19/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139184	Fee-for-Service	1467473090	1467473090	1	1	JERVIS, RAMIRO MD	9/26/2022	207R00000X	NA	Other	026	PHYSICIANS	181456	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
139235	Fee-for-Service	1093796161	1093796161	1	1	JANI, ALAP R MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101216	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139315	Fee-for-Service	1023260346	1023260346	1	1	JALIAN, HRAK R MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106413	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
139488	Fee-for-Service	1700103249	1700103249	1	1	JACQUES, DANA R MD INC	6/15/2010	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88578	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1082 SUNRISE AVE	STE 190	ROSEVILLE	CA	95661	4302	31	06061	38.72799	-121.272098	Placer County
139599	Fee-for-Service	1275661811	1275661811	1	1	JOHN MARSHALL HIGH	10/2/2006	261QS1000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SCHOOL HEALTH CENTER	3939 TRACY ST	None	LOS ANGELES	CA	90027	3207	19	06037	34.10836346	-118.278765	Los Angeles County
139644	Fee-for-Service	1306896188	1306896188	1	1	JUN, JIMMY LCSW	4/20/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
139662	Fee-for-Service	1194309724	1194309724	1	1	JOHNSON, JACOB MD	6/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184926	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
139667	Fee-for-Service	1477687135	1477687135	1	2	JEFFREY V WINSTON MD A PROFE	5/27/2015	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	1400 N HARBOR BLVD	STE 101	FULLERTON	CA	92835	9283	30	06059	33.88408114	-117.9253959	Orange County
139705	Fee-for-Service	1407055700	1407055700	1	1	JOHN CHARLES MORRIS, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
139791	Fee-for-Service	1992772552	1992772552	1	1	JACOBS, GARY M MD	6/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41820	18	Ophthalmology	0	In state provider	None	681 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.6284656	-117.0748498	San Diego County
139798	Fee-for-Service	1134466501	1134466501	1	1	JAMES PRISTER	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
139909	Fee-for-Service	1265454706	1265454706	1	4	JOHNSON, IAN R MD	6/23/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	75719	-	NOT APPLICABLE	0	In state provider	None	7240 SOUTHGATE	B, E, G, AND F	SACRAMENTO	CA	95823	2627	34	06067	38.494359	-121.438377	Sacramento County
139948	Fee-for-Service	1194309724	1194309724	1	1	JOHNSON, JACOB MD	6/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184926	27	Psychiatry Neurology (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
139954	Fee-for-Service	1477687135	1477687135	1	2	JEFFREY V WINSTON MD A PROFE	5/27/2015	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	1400 N HARBOR BLVD	STE 101	FULLERTON	CA	92835	9283	30	06059	33.88408114	-117.9253959	Orange County
140041	Fee-for-Service	1417159997	1417159997	1	1	JINICH, CAREN	2/10/2025	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
140081	Fee-for-Service	1992772552	1992772552	1	1	JACOBS, GARY M MD	6/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41820	66	Emergency Medicine (Urgent Care)	0	In state provider	None	681 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.6284656	-117.0748498	San Diego County
140175	Fee-for-Service	1710109509	1710109509	1	1	JACOBI, JOSHUA A MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55905	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
140194	Fee-for-Service	1336238575	1336238575	1	1	JEGATHEESAN, PRIYA MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78135	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
140217	Fee-for-Service	1346471224	1346471224	1	1	JHUN, KATRINA M MD	6/2/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	107084	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
140246	Fee-for-Service	1902256852	1902256852	1	1	JITTRIKAWIPHOL, JESSE DO	12/12/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15841	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
140278	Fee-for-Service	1710229851	1710229851	1	1	JOHNSON, SKYLAR H MD	7/24/2019	207P00000X	NA	Other	026	PHYSICIANS	154779	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
140302	Fee-for-Service	1326422049	1326422049	1	1	JORDAN, LYDIA	7/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5550 TELEGRAPH RD	C3	VENTURA	CA	93003	4263	56	06111	34.27717324	-119.2199411	Ventura County
140316	Fee-for-Service	1326518945	1326518945	1	1	JOSEPH, SHARON E NP	10/2/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
140329	Fee-for-Service	1013412162	1013412162	1	2	JOHNSON, ELIZABETH MD	11/30/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	164347	-	NOT APPLICABLE	0	In state provider	None	2100 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
140409	Fee-for-Service	1861409120	1861409120	1	1	JARID D. GRAY 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	1303 N MAIN ST	None	CEDAR CITY	UT	84720	0000	00	None	37.699596	-113.0664465	Iron County
140419	Fee-for-Service	1982744116	1982744116	1	1	JAMES, MIAISHA LMFT	5/24/2024	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
140429	Fee-for-Service	1407808058	1407808058	1	3	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	520 SAN JULIAN ST	None	LOS ANGELES	CA	90013	1513	19	06037	34.04395858	-118.2453502	Los Angeles County
140456	Fee-for-Service	1023694585	1023694585	1	1	JANG, NATHAN MD	7/23/2024	207P00000X	NA	Other	026	PHYSICIANS	189341	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
140462	Fee-for-Service	1811048994	1811048994	1	1	JENKINS, GARY C JR CRNA	3/30/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
140474	Fee-for-Service	1568477867	1568477867	1	1	JONATHAN JUIN-JEN CHENG, 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
140559	Fee-for-Service	1245841824	1245841824	1	1	JADHAVJI, FARAH LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
140587	Fee-for-Service	1760490221	1760490221	1	1	JERWERS, STEPHEN J DO	10/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	10057	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
140596	Fee-for-Service	1760484240	1760484240	1	1	JUE, DYRON J MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74895	41	Internal Medicine	0	In state provider	None	2101 FOREST AVE	STE 100	SAN JOSE	CA	95128	1467	43	06085	37.3270795	-121.93731	Santa Clara County
140617	Fee-for-Service	1639546120	1639546120	1	1	JJIREH LICENSED CLINICAL	8/2/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SOCIAL WORKER INC	2160 W GRANT LINE ROAD	SUITE 215	TRACY	CA	95377	7333	39	06077	37.75399922	-121.455877	San Joaquin County
140666	Fee-for-Service	1215931027	1215931027	1	1	JHAVERI, RAVI MD	2/1/2024	2085R0204X	NA	Other	026	PHYSICIANS	70390	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
140675	Fee-for-Service	1801083480	1801083480	1	1	JESSICA MEYERS NP	5/26/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9395 CROWN CREST BLVD	None	PARKER	CO	80138	8573	00	None	39.5497445	-104.7700003	Douglas County
140693	Fee-for-Service	1720043540	1720043540	1	1	JOSE ANGEL JOGLAR, 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
140717	Fee-for-Service	1407808058	1407808058	1	3	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	520 SAN JULIAN ST	None	LOS ANGELES	CA	90013	1513	19	06037	34.04395858	-118.2453502	Los Angeles County
140724	Fee-for-Service	1003248014	1003248014	1	1	JEANDRON, GARY LMFT	7/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	78401 HIGHWAY 111 UNDEFI	SUITE U	LA QUINTA	CA	92253	2066	33	06065	33.71562752	-116.2964232	Riverside County
140836	Fee-for-Service	1750588448	1750588448	1	1	JAGANNATHAN, PRASANNA MD	8/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99002	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVENUE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
140868	Fee-for-Service	1124201223	1124201223	1	1	JAFARI, ANAHITA MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108889	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
140885	Fee-for-Service	1760484240	1760484240	1	1	JUE, DYRON J MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74895	67	Endocrinology	0	In state provider	None	2101 FOREST AVE	STE 100	SAN JOSE	CA	95128	1467	43	06085	37.3270795	-121.93731	Santa Clara County
141029	Fee-for-Service	1225599558	1225599558	1	1	JOCELYN, NOELLE LMFT	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
141091	Fee-for-Service	1053349688	1053349688	1	1	JACOB-SOO, SHARON E MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100287	07	Dermatology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
141127	Fee-for-Service	1194874198	1194874198	1	1	JIMENEZ, RAFAEL M MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116128	30	Radiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
141134	Fee-for-Service	1932365251	1932365251	1	1	JAGADISH, ANUBHAV P MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125770	20	Orthopedic Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
141176	Fee-for-Service	1194821769	1194821769	1	1	JONES, KERMIT L MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101802	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
141210	Fee-for-Service	1942341524	1942341524	1	1	JONBEC CARE, INC	1/31/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12000 PEACH TREE RD	None	YUCAIPA	CA	92399	2703	36	06071	34.03664736	-117.0557226	San Bernardino County
141220	Fee-for-Service	1104280551	1104280551	1	1	JIN, SHA MD	9/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	150516	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
141226	Fee-for-Service	1043617939	1043617939	1	2	JI YON LEE MD, INC	1/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	125 N EUCLID ST	None	FULLERTON	CA	92832	1618	30	06059	33.871086	-117.9419995	Orange County
141238	Fee-for-Service	1467621938	1467621938	1	1	JIN, RICHARD Z PT	11/28/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
141252	Fee-for-Service	1285108407	1285108407	1	1	JOHNSTON, VICTORIA R RCP	2/5/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
141323	Fee-for-Service	1629505771	1629505771	1	1	JAMISON, AUTRY LMFT	3/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
141343	Fee-for-Service	1568878783	1568878783	1	1	JAVID, PARISA NP	8/4/2023	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
141408	Fee-for-Service	1730185497	1730185497	1	1	JOHN A SHERMAN 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 N MAIN ST	None	COUPEVILLE	WA	98239	3413	00	None	48.213756	-122.686102	Island County
141470	Fee-for-Service	1720127194	1720127194	1	1	JOZWIAK, ERIN M NP	7/19/2019	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
141488	Fee-for-Service	1003341751	1003341751	1	1	JORDAN, BRITTANY MD	8/9/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	179556	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
141500	Fee-for-Service	1144664145	1144664145	1	1	JASON HOBBS	2/5/2019	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
141648	Fee-for-Service	1881893394	1881893394	1	1	JAMES CHEUNG & JANA CHEN	12/3/2007	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ODS APC	4141 S NOGALES ST	STE A	WEST COVINA	CA	91792	3057	19	06037	34.00372231	-117.88765	Los Angeles County
141774	Fee-for-Service	1962550673	1962550673	1	1	JONES, KENNETH L JR MD	6/26/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	29045	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
141790	Fee-for-Service	1740743194	1740743194	1	1	JABRI, KARAM MD	8/26/2024	207RR0500X	NA	Other	026	PHYSICIANS	179345	83	Rheumatology	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
141802	Fee-for-Service	1952769481	1952769481	1	2	JACOBSON, LIA MD	3/1/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	140203	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
141820	Fee-for-Service	1013411248	1013411248	1	1	JIANG, SUE P MD	4/25/2024	207R00000X	NA	Other	026	PHYSICIANS	164280	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
141919	Fee-for-Service	1457360240	1457360240	1	1	JOHNSTON, LAURIE L MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62814	01	General Practice	0	In state provider	None	8885 LAWRENCE WELK DR	None	ESCONDIDO	CA	92026	6404	37	06073	33.23141689	-117.1419874	San Diego County
141977	Fee-for-Service	1346340551	1346340551	1	1	JACOB CHACKO	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6200 N LA CHOLLA BLVD	None	TUCSON	AZ	85741	3529	00	None	32.320323	-111.009951	Pima County
142096	Fee-for-Service	1164619243	1164619243	1	2	JUDITH M AUSTIN	12/11/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	74126 WINDFLOWER CT	None	PALM DESERT	CA	92261	2903	33	06065	33.78498948	-116.3717955	Riverside County
142099	Fee-for-Service	1457327413	1457327413	1	1	JAMESON, JENNIFER E MD	7/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	142950	None	None	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
142138	Fee-for-Service	1720267495	1720267495	1	1	JIMENEZ, AMIE L MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110037	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
142430	Fee-for-Service	1740317619	1740317619	1	1	JANCO-PLOURDE, SHARON DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	FAMILY CHIROPRACTIC CTR	2504 HARRISON AVE	STE C	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
142477	Fee-for-Service	1245481266	1245481266	1	1	JACKSON, TIMOTHY MD	1/23/2025	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	102360	20	Orthopedic Surgery	0	In state provider	None	800 S. RAYMOND AVE	None	PASADENA	CA	91105	3229	19	06037	34.13185488	-118.1487468	Los Angeles County
142615	Fee-for-Service	1023337128	1023337128	1	1	JOEL BARKLEY MD	11/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
142634	Fee-for-Service	1407936115	1407936115	1	1	JOHNSON, IAN T MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114456	None	None	0	In state provider	None	2335 KASHIAN LANE	None	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
142661	Fee-for-Service	1386729937	1386729937	1	1	JANKE, MARILYN 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	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
142675	Fee-for-Service	1841647096	1841647096	1	1	JOU, ESTHER LMFT	3/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
142722	Fee-for-Service	1952758781	1952758781	1	1	JANEO LLC	7/5/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12602-12604 VENTURA BLVD	None	STUDIO CITY	CA	91604	2414	19	06037	34.14358415	-118.4078173	Los Angeles County
142748	Fee-for-Service	1043387988	1043387988	1	1	JIMENEZ-HOWARD, GUADALUP	12/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65575	40	Pediatrics	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
142758	Fee-for-Service	1881129732	1881129732	1	1	JEAN, JENNY MD	8/2/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172775	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
142806	Fee-for-Service	1649244864	1649244864	1	1	JOGLEKAR, PRIA A MD	6/9/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	92058	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
142824	Fee-for-Service	1770146383	1770146383	1	1	JONES, STACEY	3/22/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
142871	Fee-for-Service	1619008661	1619008661	1	1	JAVAID, MOHAMMAD MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50848	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
142897	Fee-for-Service	1598076093	1598076093	1	2	JAVED, ASAD MD	4/1/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	149524	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
142941	Fee-for-Service	1285832204	1285832204	1	1	JONATHAN HOWARD	5/18/2021	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
142961	Fee-for-Service	1598829350	1598829350	1	6	JWCH INSTITUTE, INC	4/16/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3590 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2655	19	06037	33.93042906	-118.2056035	Los Angeles County
142964	Fee-for-Service	1659756526	1659756526	1	1	JOHNSON, LAUREN V LMFT	10/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10630 TOWN CENTER DR	STE 120	RANCHO CUCAMONGA	CA	91730	6889	36	06071	34.11112305	-117.5729644	San Bernardino County
143035	Fee-for-Service	1235139312	1235139312	1	1	JENNIE STUART MED CTR	4/20/2005	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	320 W 18TH ST	None	HOPKINSVILLE	KY	42240	1965	00	None	36.86056652	-87.49589513	Christian County
143073	Fee-for-Service	1184251050	1184251050	1	1	JOHNSON, SARA A MD	1/9/2024	207R00000X	NA	Other	026	PHYSICIANS	184424	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
143089	Fee-for-Service	1023196789	1023196789	1	1	JAVAHERI, PETER A MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77317	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
143133	Fee-for-Service	1205472198	1205472198	1	1	JANETS ENTERPRISE INC	8/14/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25787 MESA CT	None	SAN BERNARDINO	CA	92408	3074	36	06071	34.15444947	-117.2418255	San Bernardino County
143154	Fee-for-Service	1043297260	1043297260	2	1	JOEL NIEHUS	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5016 S US HIGHWAY 75	None	DENISON	TX	75020	4584	00	None	33.710211	-96.584958	Grayson County
143177	Fee-for-Service	1508301821	1508301821	1	1	JUNDT, JENNIFER K	4/27/2017	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
143190	Fee-for-Service	1609911932	1609911932	1	1	JOSHI, SHASHANK V MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66862	26	Psychiatry (child)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143210	Fee-for-Service	1194046581	1194046581	1	1	JINDAL, ANUJA V MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149444	79	Neurology-Child	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
143254	Fee-for-Service	1598829350	1598829350	1	6	JWCH INSTITUTE, INC	4/16/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3590 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2655	19	06037	33.93042906	-118.2056035	Los Angeles County
143371	Fee-for-Service	1154554731	1154554731	1	1	JAFARI, MEHRANEH D MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116542	28	Proctology (colon and rectal)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
143458	Fee-for-Service	1376710301	1376710301	1	1	JINDAL, JENELLE A MD	4/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	123212	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
143479	Fee-for-Service	1609911932	1609911932	1	1	JOSHI, SHASHANK V MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66862	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143500	Fee-for-Service	1194046581	1194046581	1	1	JINDAL, ANUJA V MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149444	40	Pediatrics	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
143502	Fee-for-Service	1811307325	1811307325	1	1	JASTRZEMBSKI, BENJAMIN G MD	5/4/2023	207WX0110X	NA	Ophthalmology	026	PHYSICIANS	185759	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
143511	Fee-for-Service	1043257892	1043257892	1	1	JAMRON, NEIL D MD	1/1/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33897	18	Ophthalmology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
143544	Fee-for-Service	1639279698	1639279698	1	1	JOHN T MILLER	10/24/2018	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
143551	Fee-for-Service	1699342436	1699342436	1	3	JIGSAW DIAGNOSTICS, A PROFES	11/14/2023	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SIONAL PSYCHOLOGY CORPOR	2131 ASHTON AVE	None	MENLO PARK	CA	94025	6501	41	06081	37.43205327	-122.2036961	San Mateo County
143726	Fee-for-Service	1770550931	1770550931	1	1	JONAS GARCIA, 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	1200 BINZ ST	STE 1260	HOUSTON	TX	77004	6937	00	None	29.72451078	-95.38748224	Harris County
143761	Fee-for-Service	1871988527	1871988527	1	1	JUAREZ, VERONICA J MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
143772	Fee-for-Service	1558715573	1558715573	1	1	JOHNSON, WHITNEY D MD	7/10/2020	207P00000X	NA	Other	026	PHYSICIANS	150718	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
143854	Fee-for-Service	1548224124	1548224124	1	1	JONES, LAWRENCE W MD	5/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	21999	34	Urology and Urological Surgery	0	In state provider	None	112 N MADISON AVE	None	PASADENA	CA	91101	1710	19	06037	34.147926	-118.1383915	Los Angeles County
143973	Fee-for-Service	1831777168	1831777168	1	1	JOHN, SANU P DO	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	21977	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
143975	Fee-for-Service	1083728190	1083728190	1	1	JOHNSON-CHAVIS, TONI D	7/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	32796	None	None	0	In state provider	MD INC	403 S LONG BEACH BLVD	STE B	COMPTON	CA	90221	3491	19	06037	33.89318091	-118.2078742	Los Angeles County
144065	Fee-for-Service	1427694595	1427694595	1	1	JANETS ENTERPRISE INC	8/13/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3465 DARREN PL	None	HIGHLAND	CA	92346	1658	36	06071	34.15289638	-117.23434	San Bernardino County
144076	Fee-for-Service	1063027043	1063027043	1	1	JOHNSON, MARISA L CCC-SLP	8/6/2024	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
144105	Fee-for-Service	1821344730	1821344730	1	1	JODHANI, ADITEE MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134687	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
144118	Fee-for-Service	1720241227	1720241227	1	1	JENG, JADE-MING MD	3/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115328	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	MDCC 12-311	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
144123	Fee-for-Service	1407091010	1407091010	1	1	JALILIAN-NOSRATY, AMIR-MOHAM	1/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	143284	None	None	0	In state provider	MAD MD	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
144154	Fee-for-Service	1508881434	1508881434	1	1	JOHN, ALEXANDER B CRNA	12/28/2010	367500000X	NA	Other	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
144184	Fee-for-Service	1912986621	1912986621	1	1	JI, CHENG MD	4/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72753	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
144217	Fee-for-Service	1518221894	1518221894	1	1	JOHNSON, BETH H MD	3/23/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161343	None	None	0	In state provider	None	5870 EL CAMINO REAL	100	CARLSBAD	CA	92008	8816	37	06073	33.13309467	-117.2697522	San Diego County
144221	Fee-for-Service	1992938815	1992938815	1	1	JACOBS, JEANNIE E LCSW	11/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21660 ADOBE ROAD	None	RED BLUFF	CA	96080	9043	52	06103	40.19692933	-122.2256053	Tehama County
144249	Fee-for-Service	1134792724	1134792724	1	1	JOSEPH KARANJA MUNYIRI	8/10/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13560 CABLE CREEK CT	None	RANCHO CUCAMONGA	CA	91739	2066	36	06071	34.12779844	-117.5088739	San Bernardino County
144385	Fee-for-Service	1578597993	1578597993	1	1	JOHN HOPKINS HOSP	6/4/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 N WOLFE ST	None	BALTIMORE	MD	21287	0005	00	None	39.29699223	-76.5908262	Baltimore city
144406	Fee-for-Service	1255471843	1255471843	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	YORK HOUSE	35679 DATE ST	None	YUCAIPA	CA	92399	3907	36	06071	34.04116382	-117.0262149	San Bernardino County
144462	Fee-for-Service	1487020152	1487020152	1	1	JOHANSEN, BRITTANY A OT	2/11/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
144487	Fee-for-Service	1306285739	1306285739	1	1	JHAVERI, MANAN A MD	3/25/2022	207R00000X	NA	Other	026	PHYSICIANS	168382	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
144495	Fee-for-Service	1366287476	1366287476	1	1	JEMA NON EMERGENCY MEDICAL T	7/10/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RANSPORTATION LLC	840 W AVE J	#B	LANCASTER	CA	93534	3427	19	06037	34.6893897	-118.1443748	Los Angeles County
144508	Fee-for-Service	1144427204	1144427204	1	1	JOSEBACHVILI, JONATHAN H LMF	9/12/2019	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
144536	Fee-for-Service	1134792724	1134792724	1	1	JOSEPH KARANJA MUNYIRI	8/10/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13560 CABLE CREEK CT	None	RANCHO CUCAMONGA	CA	91739	2066	36	06071	34.12779844	-117.5088739	San Bernardino County
144552	Fee-for-Service	1336276054	1336276054	1	1	JAN & GAIL'S CARE HOMES INC	12/24/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1727 N OAKS ST	None	TULARE	CA	93274	1331	54	06107	36.22951031	-119.3488935	Tulare County
144580	Fee-for-Service	1336125467	1336125467	1	1	JAMISON A TIMOTHY	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY MEDICAL SPECIA	3033 S PARKER RD,	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
144593	Fee-for-Service	1356532923	1356532923	1	1	JOEL E ARROYO MD	8/1/1984	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	SANTA ROSA MEDICAL CLINI	5305 E BEVERLY BLVD	None	LOS ANGELES	CA	90022	2103	19	06037	34.03066918	-118.1509726	Los Angeles County
144674	Fee-for-Service	1578597993	1578597993	1	1	JOHN HOPKINS HOSP	7/1/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 N WOLFE ST	None	BALTIMORE	MD	21287	0005	00	None	39.29699223	-76.5908262	Baltimore city
144675	Fee-for-Service	1427214543	1427214543	1	1	JASON MICHAEL CHESLEY, 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
144746	Fee-for-Service	1992721435	1992721435	1	1	JABOLA, BEN R	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46841	None	None	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
144819	Fee-for-Service	1619185865	1619185865	1	1	JAHANGIR, EIMAN MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140670	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
144857	Fee-for-Service	1861553182	1861553182	1	1	JACKSON, DANIEL F PHD	10/3/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
144881	Fee-for-Service	1356532923	1356532923	1	1	JOEL E ARROYO MD	8/1/1984	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	SANTA ROSA MEDICAL CLINI	5305 E BEVERLY BLVD	None	LOS ANGELES	CA	90022	2103	19	06037	34.03066918	-118.1509726	Los Angeles County
144898	Fee-for-Service	1639102346	1639102346	1	1	JANDIAL, RAJNISH MD	7/1/2001	207R00000X	NA	Other	026	PHYSICIANS	70533	41	Internal Medicine	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
144922	Fee-for-Service	1285830505	1285830505	1	1	JAMISON, KAREN H MD FACP	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95356	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
144980	Fee-for-Service	1871135400	1871135400	1	1	JUANG, CHRISTINE PHD	11/21/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
144987	Fee-for-Service	1770666281	1770666281	1	1	JENNIFER KRISTIN THILL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
144991	Fee-for-Service	1285723452	1285723452	1	1	JUSTIN ARBUCKLE M.D.	11/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4875 WARD RD	STE 600	WHEAT RIDGE	CO	80033	1944	00	None	39.784743	-105.1380255	Jefferson County
144998	Fee-for-Service	1912994237	1912994237	1	1	JANDA, PARMINDER K MD	8/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37511	41	Internal Medicine	0	In state provider	None	6045 N 1ST ST	STE 103	FRESNO	CA	93710	5444	10	06019	36.823878	-119.7723865	Fresno County
145059	Fee-for-Service	1568647022	1568647022	1	1	JAVAHERY, JILL H MD	5/3/2019	174400000X	NA	Other	026	PHYSICIANS	99753	07	Dermatology	0	In state provider	None	713 N DOUGLAS ST.	None	EL SEGUNDO	CA	90245	2830	19	06037	33.92546537	-118.3832318	Los Angeles County
145123	Fee-for-Service	1881937183	1881937183	1	1	JAIN, PRIYA K MD	11/22/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162492	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
145154	Fee-for-Service	1780647750	1780647750	1	1	JAGPAL, KULDEEP S MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56433	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
145158	Fee-for-Service	1992886261	1992886261	1	1	JACOBS, JAMES C MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	60889	22	Pathology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
145178	Fee-for-Service	1174698856	1174698856	1	1	JACOBSEN, RENNE L	7/14/2003	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	191 BURTON MESA BLVD	STE B	LOMPOC	CA	93436	1400	42	06083	34.70401649	-120.4647615	Santa Barbara County
145211	Fee-for-Service	1972504793	1972504793	1	2	JENG, ANNIE C MD	9/1/2015	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1925 BUDLONG AVE	None	LOS ANGELES	CA	90007	1109	19	06037	34.03903111	-118.2962577	Los Angeles County
145292	Fee-for-Service	1124202270	1124202270	1	1	JONES STEINBERG, STACEY L	12/24/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
145332	Fee-for-Service	1093835829	1093835829	1	2	JESSE KINCAID	7/28/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 HOSPITAL PL	None	SOLDOTNA	AK	99669	7559	00	None	60.493731	-151.077745	Kenai Peninsula Borough
145428	Fee-for-Service	1013988120	1013988120	1	1	JAMES PUTNAM MD	6/29/2016	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
145448	Fee-for-Service	1407808058	1407808058	1	4	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	515 E 6TH ST	None	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
145476	Fee-for-Service	1346453990	1346453990	1	1	JENSEN, CANDICE M MD	9/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100498	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
145487	Fee-for-Service	1477947646	1477947646	1	1	JEFFERIES, LEILANI LCSW	3/11/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	303 POTRERO ST	29-102	SANTA CRUZ	CA	95060	2741	44	06087	36.98079126	-122.030791	Santa Cruz County
145589	Fee-for-Service	1952711640	1952711640	1	1	JABAJI, DINA B DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12786	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	7900	19	06037	34.09813032	-118.2901794	Los Angeles County
145664	Fee-for-Service	1265454706	1265454706	1	2	JOHNSON, IAN R MD	11/24/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	75719	-	NOT APPLICABLE	0	In state provider	None	310 HARRIS AVENUE	SUITE A	SACRAMENTO	CA	95838	3249	34	06067	38.638134	-121.458573	Sacramento County
145777	Fee-for-Service	1639214513	1639214513	1	1	JOHN LAI AND KEVIN WONG	12/11/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL CORP	1500 SOUTHGATE AVE	STE 115	DALY CITY	CA	94015	2205	41	06081	37.67558248	-122.4750825	San Mateo County
145779	Fee-for-Service	1215306683	1215306683	1	1	JENSEN, JACOB R DPM	8/8/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3616 E 1ST ST	None	LOS ANGELES	CA	90063	2326	19	06037	34.03597969	-118.1884647	Los Angeles County
145796	Fee-for-Service	1710191820	1710191820	1	1	JENSEN, ELIZABETH R MD	6/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9962	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
146070	Fee-for-Service	1891014965	1891014965	1	1	JAISWAL, ROHIT MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 190	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
146230	Fee-for-Service	1720077084	1720077084	1	1	JENKINS, LEIGH A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LB UNIV MED CTR	602 INDIANA AVE	None	LUBBOCK	TX	79415	0000	00	None	33.58841999	-101.8880101	Lubbock County
146297	Fee-for-Service	1851790968	1851790968	1	1	JUAREZ, ESTEBAN LCSW	1/30/2020	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
146340	Fee-for-Service	1609002245	1609002245	1	1	JU, MINDY MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113336	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
146342	Fee-for-Service	1457739229	1457739229	1	1	JENDUSA, MICHAEL F MD	10/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169436	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
146419	Fee-for-Service	1295960995	1295960995	1	1	JAFARIMOJARRAD, ELHAM MD INC	2/6/2014	2084N0400X	NA	Neurology	026	PHYSICIANS	97160	13	Neurology (M.D. only)	0	In state provider	None	18 ENDEAVOR	SUITE 200	IRVINE	CA	92618	3181	30	06059	33.6675519	-117.7622659	Orange County
146422	Fee-for-Service	1427296490	1427296490	1	1	JESSICA DANIELS	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
146441	Fee-for-Service	1891047171	1891047171	1	1	JOHNSON HOLLMAN, TINA LCSW	3/16/2024	1041C0700X	NA	Mental Health Outpatient Services	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
146444	Fee-for-Service	1407923345	1407923345	1	1	JANSSEN, MARK MD	1/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	24214	22	Pathology (M.D. only)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
146475	Fee-for-Service	1740225648	1740225648	1	1	JOBST, STEVEN B MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	34326	None	None	0	In state provider	None	134 NELSON ST	None	ARROYO GRANDE	CA	93420	3386	40	06079	35.12233737	-120.576558	San Luis Obispo County
146591	Fee-for-Service	1639344302	1639344302	1	1	JOHNSON, SONIA Y MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103204	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
146604	Fee-for-Service	1487097929	1487097929	1	1	JAY, LONI D MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132204	01	General Practice	0	In state provider	None	4341-B GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	4341	09	06017	38.70594583	-120.8270239	El Dorado County
146669	Fee-for-Service	1730255944	1730255944	1	1	JOHNSON, MARK D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27756	30	Radiology	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
146687	Fee-for-Service	1972791895	1972791895	1	1	JANAKIRAM, MURALI	8/19/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	173846	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
146708	Fee-for-Service	1689751331	1689751331	1	1	JESSICA A PERINI M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 STADIUM DR	None	MORGANTOWN	WV	26506	7900	00	None	39.65330334	-79.95441785	Monongalia County
146762	Fee-for-Service	1255805487	1255805487	1	1	JANSEN, JOHN G RCP	2/5/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
146885	Fee-for-Service	1972272433	1972272433	1	1	JEONG, STACEY J CCC-SLP	1/6/2023	235Z00000X	NA	Other	037	SPEECH 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
146904	Fee-for-Service	1396130464	1396130464	1	1	JACOBSON, KAREN B MD	10/8/2018	207R00000X	NA	Other	026	PHYSICIANS	156611	41	Internal Medicine	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
146988	Fee-for-Service	1740699206	1740699206	1	1	JACKSON, ALISON M LMFT	7/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
147098	Fee-for-Service	1578191813	1578191813	1	1	JOHN-PIERCE, KAVITA MD	9/16/2023	207P00000X	NA	Other	026	PHYSICIANS	185597	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
147205	Fee-for-Service	1790089746	1790089746	1	1	JAR, WEI-YUAN 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
147226	Fee-for-Service	1427289776	1427289776	1	1	JAMISON, RYAN W DO	7/24/2013	207L00000X	NA	Other	026	PHYSICIANS	10344	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
147276	Fee-for-Service	1407808058	1407808058	1	8	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	515 E 6TH ST	None	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
147283	Fee-for-Service	1598829350	1598829350	1	9	JWCH INSTITUTE, INC	3/17/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6336 FLORENCE AVE	None	BELL GARDENS	CA	90201	4732	19	06037	33.96537744	-118.1518201	Los Angeles County
147354	Fee-for-Service	1891728051	1891728051	1	1	JODY T JACHNA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1475 KISKER RD	STE 100	SAINT CHARLES	MO	63304	8787	00	None	38.738934	-90.62136	St. Charles County
147371	Fee-for-Service	1740549278	1740549278	1	1	JUDD, CAMBRIA A MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136590	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
147410	Fee-for-Service	1669554739	1669554739	1	1	JOSEFF, DAROL D	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46420	45	Nephrology (Renal-Kidney)	0	In state provider	None	2428 CASTILLO ST	STE A	SANTA BARBARA	CA	93105	5308	42	06083	34.43122758	-119.7251364	Santa Barbara County
147559	Fee-for-Service	1407808058	1407808058	1	8	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	515 E 6TH ST	None	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
147572	Fee-for-Service	1598829350	1598829350	1	9	JWCH INSTITUTE, INC	3/17/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6336 FLORENCE AVE	None	BELL GARDENS	CA	90201	4732	19	06037	33.96537744	-118.1518201	Los Angeles County
147676	Fee-for-Service	1679524870	1679524870	1	1	JJ&R EMERGENCY MEDICAL	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GRP OF CALIFORNIA	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
147698	Fee-for-Service	1669554739	1669554739	1	1	JOSEFF, DAROL D	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46420	41	Internal Medicine	0	In state provider	None	2428 CASTILLO ST	STE A	SANTA BARBARA	CA	93105	5308	42	06083	34.43122758	-119.7251364	Santa Barbara County
147768	Fee-for-Service	1962714865	1962714865	1	1	JEFFRIES, DAVID J CO	4/3/2014	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4847 OLD REDWOOD HIGHWAY	None	SANTA ROSA	CA	95403	1415	49	06097	38.50164871	-122.7530165	Sonoma County
147798	Fee-for-Service	1376512145	1376512145	1	1	JACKSON, JUDY M MD	6/14/1994	2085R0001X	NA	Other	026	PHYSICIANS	79717	78	Neoplastic Diseases/Oncology	0	In state provider	None	2466 1ST AVE	STE B	SAN DIEGO	CA	92101	1408	37	06073	32.731137	-117.1639695	San Diego County
147880	Fee-for-Service	1699883314	1699883314	1	1	JACQUES, CHRISTOPHER J	8/31/1993	207ZP0102X	NA	Other	026	PHYSICIANS	48094	22	Pathology (M.D. only)	0	In state provider	YGNACIO PATHOLOGY MED GP	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
147936	Fee-for-Service	1386073096	1386073096	1	2	JOSEPH L LIN MD INC	4/24/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1135 S SUNSET AVE	SUITE 210	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
147962	Fee-for-Service	1881612885	1881612885	1	1	JONES, ALAN M MD	5/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
147981	Fee-for-Service	1407808058	1407808058	1	7	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	442 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2132	19	06037	34.04476398	-118.2435593	Los Angeles County
148019	Fee-for-Service	1790172534	1790172534	1	1	JIMENEZ, CHRISTINA A NP	4/17/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9052 CENTRAL AVE	None	MONTCLAIR	CA	91763	1621	36	06071	34.090191	-117.689726	San Bernardino County
148035	Fee-for-Service	1184140915	1184140915	1	1	JALALAT, PARISA M OD	10/3/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
148038	Fee-for-Service	1295034395	1295034395	1	1	JOSHUA JORDAN MEDICAL CORP	1/19/2012	193400000X	NA	Other	026	PHYSICIANS	10231	08	Family Practice	0	In state provider	None	16415 S COLORADO AVENUE	STE 410	PARAMOUNT	CA	90723	5084	19	06037	33.8853075	-118.1614695	Los Angeles County
148137	Fee-for-Service	1952666398	1952666398	1	1	JOHNSON-COLEMAN, CATRINA LP	4/15/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LPCC	224 N. RIVERSIDE AVE	STE D	RIALTO	CA	92376	5968	36	06071	34.10345211	-117.3705328	San Bernardino County
148256	Fee-for-Service	1184734618	1184734618	1	1	JOHN LIPPMANN MD	3/13/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	186 MEDICAL VILLAGE DR	None	NEWPORT	VT	05855	8537	00	None	44.95782636	-72.201591	Orleans County
148263	Fee-for-Service	1407808058	1407808058	1	7	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	442 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2132	19	06037	34.04476398	-118.2435593	Los Angeles County
148276	Fee-for-Service	1124171657	1124171657	1	2	JARUS, GLEN D MD	4/30/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6319 GREENLEAF AVE	None	WHITTIER	CA	90601	3536	19	06037	33.983928	-118.0373795	Los Angeles County
148361	Fee-for-Service	1588704084	1588704084	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	35388 FIR AVE	None	YUCAIPA	CA	92399	9633	36	06071	34.05569841	-117.0329559	San Bernardino County
148393	Fee-for-Service	1205328382	1205328382	1	1	JOHNSON, DARREN K NP	12/26/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
148456	Fee-for-Service	1386176303	1386176303	1	1	JU, ALANA C MD	6/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146816	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
148492	Fee-for-Service	1174082226	1174082226	1	1	JENSEN, MORGAN M DO	8/12/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
148496	Fee-for-Service	1770726739	1770726739	1	1	JACOB, KRYSTAL L PSYD	7/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2830 G ST	STE C2	EUREKA	CA	95501	4447	12	06023	40.78218776	-124.1624709	Humboldt County
148566	Fee-for-Service	1548372238	1548372238	1	1	JOHN ALCOCK MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
148571	Fee-for-Service	1215345806	1215345806	1	1	JAEGER, DELILAH L CNM	2/2/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
148599	Fee-for-Service	1619609039	1619609039	1	1	JULIE H HAMILTON MD INC	6/8/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2801 EUREKA WAY	None	REDDING	CA	96001	0222	45	06089	40.58569445	-122.4137153	Shasta County
148618	Fee-for-Service	1306338561	1306338561	1	1	JOSE, SEENA M MD	8/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175453	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
148619	Fee-for-Service	1760845184	1760845184	1	1	JACOBSEN, BRADLEY H MD	9/14/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	185917	None	None	0	In state provider	None	7695 CARDINAL COURT	SUITE 100	SAN DIEGO	CA	92123	3357	37	06073	32.79146985	-117.1578472	San Diego County
148681	Fee-for-Service	1568418309	1568418309	1	1	JURSON, TAMARA M MD	4/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79153	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANAN	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
148684	Fee-for-Service	1609465954	1609465954	1	1	JIN, SERENE E NP	1/19/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
148712	Fee-for-Service	1497063341	1497063341	1	1	JOHNSON, CARLA E LCSW	6/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
148810	Fee-for-Service	1922494913	1922494913	1	1	JIFFRY, ARSHAD J MD	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130065	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
148825	Fee-for-Service	1821190430	1821190430	1	1	JACOBSON, LAUREN E MD	2/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112378	None	None	0	In state provider	None	400 PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
148875	Fee-for-Service	1972583391	1972583391	1	3	JOHNSON, MICHAEL W OD	5/13/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5777 GREENBACK LANE	STE 100	SACRAMENTO	CA	95841	2013	34	06067	38.682756	-121.327839	Sacramento County
148876	Fee-for-Service	1053426320	1053426320	1	1	JAMES JOHNSON	2/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	420 WATER ST	STE 105B	KERRVILLE	TX	78028	5200	00	None	30.04925326	-99.14422258	Kerr County
148877	Fee-for-Service	1619952306	1619952306	1	4	JARUS, GLEN D MD	3/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	36924	18	Ophthalmology	0	In state provider	None	1401 N TUSTIN AVE	STE 220	SANTA ANA	CA	92705	8689	30	06059	33.757254	-117.8341425	Orange County
148917	Fee-for-Service	1952637019	1952637019	1	1	JUICE, DAVID P MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129038	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
148944	Fee-for-Service	1194488866	1194488866	1	2	JESSICA PEREZ LICENSED PROFE	4/29/2024	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4740 GREEN RIVER RD	206A	CORONA	CA	92878	9185	33	06065	33.87742363	-117.6611817	Riverside County
149042	Fee-for-Service	1407918246	1407918246	1	1	JAMES E PAUTZ, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21601 76TH AVE W	None	EDMONDS	WA	98026	7507	00	None	47.803239	-122.335652	Snohomish County
149066	Fee-for-Service	1699197590	1699197590	1	1	JACQUELINE ANN BRAZIL-COOPER	1/16/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3390 COUNTRY VILLAGE RD	STE 2217	RIVERSIDE	CA	92509	1084	33	06065	34.02775204	-117.50692	Riverside County
149109	Fee-for-Service	1497928832	1497928832	2	1	JSK FAMILY PHARMICIES, INC	8/31/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8010 2ND STREET	None	PARAMOUNT	CA	90723	3404	19	06037	33.89819155	-118.159623	Los Angeles County
149185	Fee-for-Service	1154587616	1154587616	1	1	JAVED, HUMA DO	10/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10652	41	Internal Medicine	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149229	Fee-for-Service	1194488866	1194488866	1	2	JESSICA PEREZ LICENSED PROFE	4/29/2024	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4740 GREEN RIVER RD	206A	CORONA	CA	92878	9185	33	06065	33.87742363	-117.6611817	Riverside County
149267	Fee-for-Service	1710929690	1710929690	1	2	JESUS SAENZ 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	4760 E GERMANN RD	None	GILBERT	AZ	85297	0205	00	None	33.27894	-111.6869805	Maricopa County
149316	Fee-for-Service	1376800342	1376800342	1	1	JOODI, ROBERT N MD	11/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191426	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
149328	Fee-for-Service	1437161452	1437161452	1	1	JOHN MUIR HEALTH	9/4/1981	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2298 PIKE CT	None	CONCORD	CA	94520	1251	07	06013	38.01089373	-122.033997	Contra Costa County
149365	Fee-for-Service	1699197590	1699197590	1	1	JACQUELINE ANN BRAZIL-COOPER	1/16/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3390 COUNTRY VILLAGE RD	STE 2217	RIVERSIDE	CA	92509	1084	33	06065	34.02775204	-117.50692	Riverside County
149402	Fee-for-Service	1639213564	1639213564	1	1	JOHNS, DIANA M MD	1/30/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	41091	05	Anesthesiology	0	In state provider	None	1887 MONTEREY RD	STE 200	SAN JOSE	CA	95112	6136	43	06085	37.308636	-121.8664102	Santa Clara County
149461	Fee-for-Service	1972656031	1972656031	1	1	JOHNSON, JULIA W LCSW	3/5/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10517 OAK CREEK DR	None	LAKESIDE	CA	92040	1624	37	06073	32.8688524	-116.9434852	San Diego County
149476	Fee-for-Service	1982711222	1982711222	1	1	JAKIM, NINA I MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64386	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
149516	Fee-for-Service	1194488866	1194488866	1	2	JESSICA PEREZ LICENSED PROFE	4/29/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4740 GREEN RIVER RD	206A	CORONA	CA	92878	9185	33	06065	33.87742363	-117.6611817	Riverside County
149573	Fee-for-Service	1760702237	1760702237	1	2	JEAN RIZKALLAH, MD, INC	8/23/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	450 FOURTH AVE.	STE 408	CHULA VISTA	CA	91910	4430	37	06073	32.63513513	-117.0820663	San Diego County
149584	Fee-for-Service	1639690142	1639690142	1	1	JUDELSON, RICHARD MD	7/5/2023	207ZP0102X	NA	Other	026	PHYSICIANS	175688	None	None	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
149588	Fee-for-Service	1679680177	1679680177	1	1	JONES, HENRY W MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	34016	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
149623	Fee-for-Service	1396122081	1396122081	1	1	JABAIAH, AHMAD MD	3/4/2020	207R00000X	NA	Other	026	PHYSICIANS	150358	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
149681	Fee-for-Service	1457609992	1457609992	1	1	JOHAL, RUPINDER K MD	4/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123213	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
149711	Fee-for-Service	1316011190	1316011190	1	1	JACKSON, CHRIS E LMFT	6/12/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
149755	Fee-for-Service	1154342962	1154342962	2	1	JAMES MCKINNON MD	1/11/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
149822	Fee-for-Service	1992251862	1992251862	1	1	JONES, SHAQUIL D LMFT	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2295 HILLTOP DR	STE #7	REDDING	CA	96002	0515	45	06089	40.57406508	-122.3579629	Shasta County
149895	Fee-for-Service	1548399538	1548399538	1	1	JACKSON, KEITH W MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46539	05	Anesthesiology	0	In state provider	None	235 N HOOVER ST	None	LOS ANGELES	CA	90004	3627	19	06037	34.07580952	-118.283404	Los Angeles County
149979	Fee-for-Service	1831401579	1831401579	1	1	JENNINGS, ALYXANDRA L PSYD	8/13/2021	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
149982	Fee-for-Service	1124171657	1124171657	1	1	JARUS, GLEN D MD	4/30/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1135 S SUNSET AVE	STE 407	WEST COVINA	CA	91790	6964	19	06037	34.06215064	-117.9453997	Los Angeles County
150023	Fee-for-Service	1710065206	1710065206	1	1	JUNIA, JODY ALLAN S MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94023	01	General Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
150038	Fee-for-Service	1205332756	1205332756	1	1	JEONG, VANESSA OT	10/15/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
150048	Fee-for-Service	1932304821	1932304821	1	1	JU, JOHNNY H MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98362	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
150049	Fee-for-Service	1518441773	1518441773	1	1	JACKSON, DARCY	5/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2918 ALBATROSS WAY	None	SACRAMENTO	CA	95815	1903	34	06067	38.619036	-121.422708	Sacramento County
150061	Fee-for-Service	1831246966	1831246966	1	1	JACOBS, ELISABETH D MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75610	08	Family Practice	0	In state provider	None	631 E ALVIN DR	STE J1	SALINAS	CA	93906	3056	27	06053	36.7035675	-121.6319376	Monterey County
150073	Fee-for-Service	1083694608	1083694608	1	1	JOHANNA R ASKEGARD-GIESMANN	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
150115	Fee-for-Service	1598499337	1598499337	1	1	JACKSON, ERIN B NP	11/16/2023	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
150116	Fee-for-Service	1154880920	1154880920	1	1	JAMA, ABDULLAHI MD	2/8/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
150138	Fee-for-Service	1790827673	1790827673	1	1	JUNG, MAN Y	10/23/1986	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2264 LINCOLN AVE	None	ALTADENA	CA	91001	5433	19	06037	34.18469195	-118.1596824	Los Angeles County
150142	Fee-for-Service	1801217435	1801217435	1	2	J L AND J INC	3/21/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	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
150238	Fee-for-Service	1588090674	1588090674	1	1	JILK, JEFFREY W MD	8/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147837	40	Pediatrics	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
150300	Fee-for-Service	1083660864	1083660864	1	1	JOHNSON, BRYCE A	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90171	None	None	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
150368	Fee-for-Service	1063998615	1063998615	1	1	JAMES F MITCHELL JR MD INC	9/18/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2705 LOMA VISTA RD	206	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
150422	Fee-for-Service	1639136534	1639136534	1	1	JOHNSON, THOMAS M	7/10/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	81064	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
150437	Fee-for-Service	1790244523	1790244523	1	1	JEFFERSON, JAMAL M MD	5/31/2022	207P00000X	NA	Other	026	PHYSICIANS	177249	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
150508	Fee-for-Service	1720439128	1720439128	1	1	JANET C CONNEY, MD, INC.	9/3/2019	261QM2500X	NA	Other	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	12062 VALLEY VIEW ST	SUITE 129	GARDEN GROVE	CA	92845	1737	30	06059	33.78720885	-118.028413	Orange County
150582	Fee-for-Service	1710369905	1710369905	1	1	JANAKI, NAFISEH MD	8/16/2022	207ZP0102X	NA	Other	026	PHYSICIANS	177350	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
150790	Fee-for-Service	1508546409	1508546409	1	1	JUDD ASSISTED LIVING	2/14/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12615 JUDD ST	None	PACOIMA	CA	91331	1319	19	06037	34.28050901	-118.4081352	Los Angeles County
150794	Fee-for-Service	1619338209	1619338209	1	1	JOHN F KENNEDY UNIVERSITY	4/11/2016	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
150798	Fee-for-Service	1720439128	1720439128	1	1	JANET C CONNEY, MD, INC.	9/3/2019	261QM2500X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	12062 VALLEY VIEW ST	SUITE 129	GARDEN GROVE	CA	92845	1737	30	06059	33.78720885	-118.028413	Orange County
150882	Fee-for-Service	1952714891	1952714891	1	1	JOHNSON, ALEX DO	3/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15280	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
150938	Fee-for-Service	1073710935	1073710935	1	1	JACOBSON, DEBORAH B PHD	12/7/2004	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
150991	Fee-for-Service	1407808058	1407808058	1	11	JWCH INSTITUTE INC	5/24/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5502 K ST	BUILDING C	BELL	CA	90201	6484	19	06037	33.98856784	-118.1679868	Los Angeles County
151061	Fee-for-Service	1659680395	1659680395	1	1	JONES, JASMINE R LCSW	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79951	-	NOT APPLICABLE	0	In state provider	None	370 S CRENSHAW BLVD	SUITE E-100	TORRANCE	CA	90503	1727	19	06037	33.84549	-118.3287415	Los Angeles County
151082	Fee-for-Service	1619338209	1619338209	1	1	JOHN F KENNEDY UNIVERSITY	4/11/2016	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
151107	Fee-for-Service	1104806397	1104806397	1	1	JERDEE, THEODORE J MD	9/11/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53747	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
151257	Fee-for-Service	1417039942	1417039942	1	1	JOE, STANTON H MD INC	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	22872	30	Radiology	0	In state provider	None	1500 S CENTRAL AVE	STE 116	GLENDALE	CA	91204	2586	19	06037	34.12736888	-118.257777	Los Angeles County
151276	Fee-for-Service	1407808058	1407808058	1	11	JWCH INSTITUTE INC	5/24/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5502 K ST	BUILDING C	BELL	CA	90201	6484	19	06037	33.98856784	-118.1679868	Los Angeles County
151330	Fee-for-Service	1124259767	1124259767	1	1	JOE, TIFFANY D MD	9/24/2019	207P00000X	NA	Other	026	PHYSICIANS	114234	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
151359	Fee-for-Service	1023132990	1023132990	1	1	JEPSON, JILL D NP	4/2/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1550 TOWN CENTER DRIVE	None	MONTEBELLO	CA	90640	2173	19	06037	34.03650569	-118.0887188	Los Angeles County
151459	Fee-for-Service	1285815605	1285815605	1	1	JIMMY D NGUYEN	3/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6567 E CARONDELET DR	STE 305	TUCSON	AZ	85710	6160	00	None	32.226876	-110.8535445	Pima County
151478	Fee-for-Service	1831367960	1831367960	1	1	JAMES, JENNIFER J LMFT	8/27/2018	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
151487	Fee-for-Service	1669600466	1669600466	1	1	JARJOUS, WAED DO	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12401	40	Pediatrics	0	In state provider	None	33353 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2018	36	06071	34.03379369	-117.0765405	San Bernardino County
151518	Fee-for-Service	1962559906	1962559906	1	1	JAMARI, MONTRIEL V LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 EAST AVE	SUITE 4C	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
151570	Fee-for-Service	1528058336	1528058336	1	1	JAMES KIMO TAKAYESU MD	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRUIT ST	None	BOSTON	MA	02114	2621	00	None	42.363216	-71.0687745	Suffolk County
151600	Fee-for-Service	1003975509	1003975509	1	1	JIMENEZ, JESUS MD	1/5/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	192132	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
151602	Fee-for-Service	1962572115	1962572115	1	1	JEDRZYNSKI, MICHAEL S MD	10/31/1990	174400000X	NA	Other	026	PHYSICIANS	60011	18	Ophthalmology	0	In state provider	None	6660 COYLE AVE	STE 300	CARMICHAEL	CA	95608	6367	34	06067	38.667447	-121.3091505	Sacramento County
151645	Fee-for-Service	1043752397	1043752397	1	1	JASSO, ERNESTO PT	11/3/2019	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
151670	Fee-for-Service	1154958437	1154958437	1	1	JACKSON, MEGAN MD	6/5/2024	207P00000X	NA	Other	026	PHYSICIANS	186268	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
151678	Fee-for-Service	1740239607	1740239607	1	1	JALALI, SHAHRAM MD	5/5/2008	207L00000X	NA	Other	026	PHYSICIANS	82712	05	Anesthesiology	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4597	19	06037	34.19395645	-118.463265	Los Angeles County
151763	Fee-for-Service	1972670974	1972670974	1	1	JUNG, ILONA M MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34893	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
151764	Fee-for-Service	1720026958	1720026958	1	2	JOLA HOME HEALTH SERVICE INC	4/7/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	323 N PRAIRIE AVENUE	SUITE 425	INGLEWOOD	CA	90301	4506	19	06037	33.966333	-118.3439975	Los Angeles County
151799	Fee-for-Service	1699989939	1699989939	1	1	JALIL, SAJID	1/19/2024	207RG0100X	NA	Gastroenterology	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
151819	Fee-for-Service	1295730406	1295730406	1	1	JONES, RICHARD D OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 4TH ST	None	SANTA ROSA	CA	95404	4505	49	06097	38.441916	-122.710518	Sonoma County
151842	Fee-for-Service	1295355816	1295355816	1	1	JACKSON, TYLER P MD	6/10/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
151882	Fee-for-Service	1013050996	1013050996	1	1	JACOBS, CATHERINE L	10/1/2007	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
151891	Fee-for-Service	1962572115	1962572115	1	1	JEDRZYNSKI, MICHAEL S MD	10/31/1990	174400000X	NA	Other	026	PHYSICIANS	60011	24	Plastic Surgery	0	In state provider	None	6660 COYLE AVE	STE 300	CARMICHAEL	CA	95608	6367	34	06067	38.667447	-121.3091505	Sacramento County
151934	Fee-for-Service	1437154739	1437154739	1	1	JUAN D POSADA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500R E RIDGE RD	STE 300	MCALLEN	TX	78503	1505	00	None	26.18493962	-98.21742425	Hidalgo County
152051	Fee-for-Service	1972670974	1972670974	1	1	JUNG, ILONA M MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34893	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
152138	Fee-for-Service	1003149956	1003149956	1	1	JARA, YVETTE A LCSW	12/20/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
152181	Fee-for-Service	1902335961	1902335961	1	1	JALALZADEH, MOJGAN MD	6/26/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	183191	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
152211	Fee-for-Service	1326193632	1326193632	1	1	JOHNSON, JAN M MD	11/5/2018	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	67007	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
152365	Fee-for-Service	1043441116	1043441116	1	1	JONES, MRGAN PHD	9/22/2011	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
152409	Fee-for-Service	1538231345	1538231345	1	1	JUMPER, JACQUE R MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77470	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
152420	Fee-for-Service	1366484362	1366484362	1	1	JONES, GREGORY M MD	12/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43544	01	General Practice	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
152506	Fee-for-Service	1851464713	1851464713	1	1	JAEGER, CHRISTOPHER J MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68104	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
152509	Fee-for-Service	1922514686	1922514686	1	1	JJDAC, LLC	7/5/2018	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	None	208 W MALONEY AVENUE	None	GALLUP	NM	87301	5214	00	None	35.53095046	-108.7447523	McKinley County
152588	Fee-for-Service	1811077498	1811077498	1	1	JENSEN, RICHARD	9/19/2005	207XX0004X	NA	Orthopedic Surgery	027	PODIATRISTS	-	None	None	0	In state provider	None	325 N MATHILDA AVE	None	SUNNYVALE	CA	94085	4207	43	06085	37.38581522	-122.0316838	Santa Clara County
152642	Fee-for-Service	1659991735	1659991735	1	1	JAMITH, DEANDREA N LPCC	11/23/2022	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
152678	Fee-for-Service	1710234075	1710234075	1	1	JEWELL, BRITTON R DO	3/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14937	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
152749	Fee-for-Service	1649394537	1649394537	1	1	JONES, DAWN M 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
152790	Fee-for-Service	1518978246	1518978246	1	1	JIRARI, BACHIR MD INC	10/1/1995	207L00000X	NA	Other	026	PHYSICIANS	29539	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
152819	Fee-for-Service	1396867867	1396867867	1	2	JOHNSON, ALEXANDRA A LCSW	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25747	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVENUE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
152822	Fee-for-Service	1528346616	1528346616	1	1	JANJUGHAZOVA, SHAHANE MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132867	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
152831	Fee-for-Service	1528118171	1528118171	1	1	JONES, MEGAN K MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96819	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
152862	Fee-for-Service	1932318748	1932318748	1	1	JEFFCOAT, DEVON M MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95846	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
152924	Fee-for-Service	1336684893	1336684893	1	1	JOSE SOLIS COBIAN	3/25/2019	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	SUITE 245E	CATHEDRAL CITY	CA	92234	7015	33	06065	33.79144444	-116.4581341	Riverside County
152985	Fee-for-Service	1578101663	1578101663	1	1	JANET'S ENTERPRISE INC	5/21/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11489 LAUREL AVE	None	LOMA LINDA	CA	92354	6712	36	06071	34.04403103	-117.2267937	San Bernardino County
153045	Fee-for-Service	1538844881	1538844881	1	1	JOSHUA CROSE MEDICAL INCORPO	5/15/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
153198	Fee-for-Service	1134460603	1134460603	1	2	JAMES, MELODY CNP	2/25/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95018039	-	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
153220	Fee-for-Service	1104914019	1104914019	1	1	JAMAL, NASER M DO	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8143	41	Internal Medicine	0	In state provider	None	1700 N ROSE AVE	SUITE 210	OXNARD	CA	93030	7639	56	06111	34.21746	-119.155545	Ventura County
153333	Fee-for-Service	1538844881	1538844881	1	1	JOSHUA CROSE MEDICAL INCORPO	4/9/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
153334	Fee-for-Service	1922426998	1922426998	1	1	JACKSON, ANNA L MD	1/8/2020	207L00000X	NA	Other	026	PHYSICIANS	141858	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
153469	Fee-for-Service	1497153860	1497153860	1	2	JAKLE, HALSEY C MD	9/8/2017	207P00000X	NA	Other	026	PHYSICIANS	133022	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0000	34	06067	38.669562	-121.31379	Sacramento County
153509	Fee-for-Service	1205869807	1205869807	1	1	JAUREGUI, NICHOLAS J MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62786	08	Family Practice	0	In state provider	None	550 WASHINGTON ST	STE 841	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
153513	Fee-for-Service	1235349291	1235349291	1	1	JASMINE BADILLO AND TERESITA	3/19/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	REYES	2673 VISTA BONITA CT	None	FAIRFIELD	CA	94534	1729	48	06095	38.2706337	-122.0587304	Solano County
153616	Fee-for-Service	1538844881	1538844881	1	1	JOSHUA CROSE MEDICAL INCORPO	10/4/2023	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
153676	Fee-for-Service	1871552364	1871552364	1	1	JARAVATA, DANILO V MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52971	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
153691	Fee-for-Service	1083891717	1083891717	1	1	JOHN MUIR PHY NETWORK	2/13/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	907 SAN RAMON VLLY BLVD	STE 202	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
153747	Fee-for-Service	1629022488	1629022488	1	1	JERARDI, MARIA J MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87482	08	Family Practice	0	In state provider	None	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	10	06019	36.76619136	-120.3839072	Fresno County
153751	Fee-for-Service	1407808058	1407808058	1	5	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	115 E 3RD ST	None	LOS ANGELES	CA	90013	1301	19	06037	34.04901858	-118.2454969	Los Angeles County
153769	Fee-for-Service	1124244520	1124244520	1	1	JESPERSEN, RHONDA M	3/28/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6229 W 87TH ST	None	LOS ANGELES	CA	90045	3901	19	06037	33.95860798	-118.3941238	Los Angeles County
153796	Fee-for-Service	1205869807	1205869807	1	1	JAUREGUI, NICHOLAS J MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62786	15	Obstetrics (D.O. only)	0	In state provider	None	550 WASHINGTON ST	STE 841	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
153877	Fee-for-Service	1174682793	1174682793	1	1	JUE, LINDA MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52770	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
153906	Fee-for-Service	1538844881	1538844881	1	1	JOSHUA CROSE MEDICAL INCORPO	10/4/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
153940	Fee-for-Service	1467457747	1467457747	1	1	JOHNSON,MYSTIC MD	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
153965	Fee-for-Service	1124329594	1124329594	1	1	JEKUMS, THEODORE J MD PC	10/29/2012	208600000X	NA	General Surgery	026	PHYSICIANS	23626	02	General Surgery	0	In state provider	None	1801 W ROMNEYA DR	STE 404	ANAHEIM	CA	92801	1826	30	06059	33.8506615	-117.946413	Orange County
153975	Fee-for-Service	1205985082	1205985082	1	1	JORDAN, DONNA R	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58700	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
153994	Fee-for-Service	1407808058	1407808058	1	6	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1845 N FAIR OAKS AVE	SUITE 1101	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
154009	Fee-for-Service	1609389139	1609389139	1	1	JENNIFER CHE OD A PROFESSION	6/21/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	625 W 9TH ST	None	SAN PEDRO	CA	90731	3107	19	06037	33.73602552	-118.2906945	Los Angeles County
154038	Fee-for-Service	1417134826	1417134826	1	1	JAMRON, JEANETTE S MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97559	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
154040	Fee-for-Service	1407808058	1407808058	1	5	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	115 E 3RD ST	None	LOS ANGELES	CA	90013	1301	19	06037	34.04901858	-118.2454969	Los Angeles County
154085	Fee-for-Service	1205869807	1205869807	1	1	JAUREGUI, NICHOLAS J MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62786	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	550 WASHINGTON ST	STE 841	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
154093	Fee-for-Service	1730632886	1730632886	1	1	JADAUJI, JAHAN B MD	7/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165967	15	Obstetrics (D.O. only)	0	In state provider	None	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
154166	Fee-for-Service	1174682793	1174682793	1	1	JUE, LINDA MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52770	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
154176	Fee-for-Service	1184980161	1184980161	1	1	JIMENEZ DE ALAS,CLAUDIA J MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118287	40	Pediatrics	0	In state provider	None	341 MAGNOLIA AVENUE	SUITE 201	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
154218	Fee-for-Service	1265489546	1265489546	1	1	JAMSHIDINIA, KAMRAN DPM	3/1/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2080 CENTURY PARK E	SUITE 1508	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
154279	Fee-for-Service	1407808058	1407808058	1	6	JWCH INSTITUTE INC	2/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1845 N FAIR OAKS AVE	SUITE 1101	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
154380	Fee-for-Service	1730632886	1730632886	1	1	JADAUJI, JAHAN B MD	7/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165967	09	Gynecology (D.O. only)	0	In state provider	None	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
154460	Fee-for-Service	1790955458	1790955458	1	1	JAMES, JOYCE V LCSW	12/18/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 SPRING ST	STE 306	LA MESA	CA	91942	0263	37	06073	32.76503682	-117.0203822	San Diego County
154485	Fee-for-Service	1376282491	1376282491	1	1	JONES, SHAINA M AU	8/22/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
154496	Fee-for-Service	1275563660	1275563660	1	2	JIAN-MIN ACUPUNCTURE CLINIC	1/10/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	833 ALPINE STREET	None	LOS ANGELES	CA	90012	6402	19	06037	34.06401824	-118.245101	Los Angeles County
154540	Fee-for-Service	1396131819	1396131819	1	1	JHA, PRASHANT R MD	10/24/2019	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
154604	Fee-for-Service	1215015052	1215015052	1	1	JOHNSON, SCOT P MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72297	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
154673	Fee-for-Service	1003258930	1003258930	1	1	JORDAN, CHARANDLE S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133826	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
154724	Fee-for-Service	1811355464	1811355464	1	1	JOHNSON, HEIDI LMFT	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
154742	Fee-for-Service	1104157395	1104157395	1	1	JEFFREY, ALANNA R LMFT	8/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE	STE 219	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
154765	Fee-for-Service	1922049295	1922049295	1	1	JACKSON, MELVIN L MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	32876	41	Internal Medicine	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
154773	Fee-for-Service	1053361212	1053361212	1	1	JEREL M ZOLITICK MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 ATWELL RD	None	COOPERSTOWN	NY	13326	1301	00	None	42.695262	-74.9230425	Otsego County
154964	Fee-for-Service	1427546829	1427546829	1	1	JAUREGUI, KAREN LMFT	2/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
155009	Fee-for-Service	1306089776	1306089776	1	1	JANE SERENE LIMMER M.D.	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
155052	Fee-for-Service	1194996405	1194996405	1	1	JOSEPHY, CLAYTON P MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112372	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
155053	Fee-for-Service	1922049295	1922049295	1	1	JACKSON, MELVIN L MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	32876	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
155122	Fee-for-Service	1114917473	1114917473	1	1	JAMALI, AMIR A MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61055	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
155299	Fee-for-Service	1457710998	1457710998	1	1	JOSHI, NARESH K MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142298	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
155426	Fee-for-Service	1467566158	1467566158	1	1	JONES, KATHERINE MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40047	40	Pediatrics	0	In state provider	None	1350 S ELISEO DR	None	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
155446	Fee-for-Service	1427133040	1427133040	1	1	JOU, MIKE C DPM INC	2/1/1999	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1661 HANOVER RD	STE 104	CITY OF INDUSTRY	CA	91748	1734	19	06037	33.99109665	-117.920988	Los Angeles County
155461	Fee-for-Service	1407847734	1407847734	1	1	JONES, STEVEN K MD	8/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43042	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
155499	Fee-for-Service	1881349181	1881349181	1	1	JOHNSON, TIYA S LPCC	2/5/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 E COOLEY DR	SUITE 200A	COLTON	CA	92324	3939	36	06071	34.05447652	-117.305298	San Bernardino County
155505	Fee-for-Service	1316108038	1316108038	1	1	JACOB, GABRIEL MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107534	18	Ophthalmology	0	In state provider	None	320 H STREET	SUITE 4	MARYSVILLE	CA	95901	5834	58	06115	39.13837241	-121.5948806	Yuba County
155540	Fee-for-Service	1871020206	1871020206	1	1	JERNIGAN, TAMEKIA N	6/8/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	13512 WHITTIER BLVD	G-3	WHITTIER	CA	90605	0000	19	06037	33.96024	-118.032381	Los Angeles County
155548	Fee-for-Service	1649233313	1649233313	1	1	JEANNETTE WADE	2/17/2021	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 N MAYFAIR RD	None	WAUWATOSA	WI	53226	4216	00	None	43.03206488	-88.04735576	Milwaukee County
155562	Fee-for-Service	1669639175	1669639175	1	1	JOSEPH, TIMMY M MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109464	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
155596	Fee-for-Service	1932183191	1932183191	1	1	JAMES E GERACE, JR., M.D	11/14/2011	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
155614	Fee-for-Service	1396752689	1396752689	1	1	JIMENEZ, CONSEPCION NP	2/22/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5015 WHITTIER	None	LOS ANGELES	CA	90022	3116	19	06037	34.02129255	-118.1613094	Los Angeles County
155630	Fee-for-Service	1679558605	1679558605	1	1	JAVIDAN-NEJAD, JAVID MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83658	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
155700	Fee-for-Service	1780974931	1780974931	1	1	JALILIAN, LALEH MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124609	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
155733	Fee-for-Service	1285947804	1285947804	1	1	JAFARI, HAMTA MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118827	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
155749	Fee-for-Service	1407847734	1407847734	1	1	JONES, STEVEN K MD	8/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43042	08	Family Practice	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
155789	Fee-for-Service	1497047070	1497047070	1	1	JUANLU MEDICAL CORPORATION	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	9758	41	Internal Medicine	0	In state provider	None	355 DARDANELLI LANE	None	LOS GATOS	CA	95032	1438	43	06085	37.262493	-121.967456	Santa Clara County
155797	Fee-for-Service	1619155041	1619155041	1	1	JOSEPH K SONG MD INC	4/1/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	69832	41	Internal Medicine	0	In state provider	None	7571 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2315	30	06059	33.86987112	-118.0011759	Orange County
155893	Fee-for-Service	1164578795	1164578795	1	1	JACOBSON, JANET C MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126260	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
155991	Fee-for-Service	1346448925	1346448925	1	1	JOHN ARTHUR MILLER MD	3/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
156084	Fee-for-Service	1619155041	1619155041	1	1	JOSEPH K SONG MD INC	4/1/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	69832	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7571 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2315	30	06059	33.86987112	-118.0011759	Orange County
156123	Fee-for-Service	1285223552	1285223552	1	2	JIVA HEALTH, INC	3/4/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	2601 NUT TREE RD	SUITE B	VACAVILLE	CA	95687	6918	48	06095	38.33422507	-121.9531913	Solano County
156131	Fee-for-Service	1730686171	1730686171	1	1	JONES, MIARAH LCSW	11/1/2024	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
156145	Fee-for-Service	1720474349	1720474349	1	1	JAMN EXPRESS LINE, LLC	10/14/2015	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1501 CORPORATE WAY	SUITE 110	SACRAMENTO	CA	95833	3887	34	06067	38.492604	-121.5201645	Sacramento County
156165	Fee-for-Service	1619127537	1619127537	1	1	JACKSON, ANNE E PHD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17785	-	NOT APPLICABLE	0	In state provider	None	1466 LINCOLN AVE	None	SAN RAFAEL	CA	94901	2021	21	06041	37.98004532	-122.5221262	Marin County
156187	Fee-for-Service	1265609119	1265609119	1	1	JIFFRY MEDICAL CORPORATION	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43501	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVENUE	STE 312	SAN BERNARDINO	CA	92404	3855	36	06071	34.1358627	-117.2757898	San Bernardino County
156250	Fee-for-Service	1417973496	1417973496	1	1	JOSEPH LUCKOSE CHATHAM, MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 S POWER RD	STE 101	MESA	AZ	85206	5210	00	None	33.411105	-111.683349	Maricopa County
156277	Fee-for-Service	1144408154	1144408154	1	1	JILL WEINER MD	2/24/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9397 CROWN CREST BLVD	None	PARKER	CO	80138	8575	00	None	39.5497445	-104.7700003	Douglas County
156306	Fee-for-Service	1235660515	1235660515	1	1	JAMILI, MARYAM LMFT	7/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27001 LA PAZ RD	STE. 448-B	MISSION VIEJO	CA	92691	5526	30	06059	33.59720291	-117.6586999	Orange County
156402	Fee-for-Service	1063569549	1063569549	1	1	JOHNSONHILL, BRENDA A MFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23979	-	NOT APPLICABLE	0	In state provider	None	1393 BAILEY DR	None	HANFORD	CA	93230	5922	16	06031	36.32726257	-119.6663418	Kings County
156412	Fee-for-Service	1285223552	1285223552	1	2	JIVA HEALTH, INC	3/4/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	2601 NUT TREE RD	SUITE B	VACAVILLE	CA	95687	6918	48	06095	38.33422507	-121.9531913	Solano County
156445	Fee-for-Service	1124186754	1124186754	1	1	JOYO, COLIN I MD	6/7/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	47720	None	None	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
156512	Fee-for-Service	1942591847	1942591847	1	1	JONAH MEDICAL GROUP INC	8/8/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3545 WILSHIRE BLVD	STE 202	LOS ANGELES	CA	90010	2378	19	06037	34.0617575	-118.301985	Los Angeles County
156601	Fee-for-Service	1447340393	1447340393	1	1	JORDAN, CAROLYN DIANA MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	MS 359110 C/O UWP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
156605	Fee-for-Service	1114132008	1114132008	2	1	J-J QUAL-ZERV INC	11/10/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	20318 STRATHERN ST	None	WINNETKA	CA	91306	2228	19	06037	34.21555809	-118.5760083	Los Angeles County
156620	Fee-for-Service	1114092186	1114092186	1	1	JAJODIA, PRAHALAD B MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56084	10	Gastroenterology (M.D. only)	0	In state provider	DIGESTIVE AND LIVER DISE	6137 N THESTA ST	STE 103	FRESNO	CA	93710	8605	10	06019	36.82557364	-119.783138	Fresno County
156660	Fee-for-Service	1326543752	1326543752	1	1	JACKSON, TAYLOR J MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	184355	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
156676	Fee-for-Service	1770110900	1770110900	1	1	JOHNSON, TYRONE A MD	6/17/2023	208M00000X	NA	Other	026	PHYSICIANS	186265	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
156683	Fee-for-Service	1780144303	1780144303	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2151 E PALMDALE	None	PALMDALE	CA	93550	4037	19	06037	34.58013142	-118.0898273	Los Angeles County
156687	Fee-for-Service	1689103707	1689103707	1	1	JOANNA NGUYEN, MD INC	10/27/2021	208200000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	9201 W SUNSET BLVD	STE 718	WEST HOLLYWOOD	CA	90069	3708	19	06037	34.09054375	-118.392295	Los Angeles County
156698	Fee-for-Service	1285223552	1285223552	1	2	JIVA HEALTH, INC	3/4/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2601 NUT TREE RD	SUITE B	VACAVILLE	CA	95687	6918	48	06095	38.33422507	-121.9531913	Solano County
156722	Fee-for-Service	1871776161	1871776161	1	1	JUNG, MIRANDA H PHD	2/8/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
156745	Fee-for-Service	1982701355	1982701355	1	2	JONG, LAURA T MD	10/19/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	82124	None	None	0	In state provider	None	23430 HAWTHORNE BLVD	SUITE 280	TORRANCE	CA	90505	4764	19	06037	33.81316465	-118.3510077	Los Angeles County
156779	Fee-for-Service	1154541423	1154541423	1	1	JOSHI, NITIN D MD	6/8/2010	207R00000X	NA	Other	026	PHYSICIANS	93287	41	Internal Medicine	0	In state provider	None	20055 LAKE CHABOT RD	STE 130	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
156796	Fee-for-Service	1770562712	1770562712	1	1	JOHNSON, CHRISTOPHER W MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	77635	34	Urology and Urological Surgery	0	In state provider	None	525 EAST PLAZA DR	STE 202	SANTA MARIA	CA	93454	6955	42	06083	34.9373822	-120.4296004	Santa Barbara County
156850	Fee-for-Service	1487273207	1487273207	1	1	JEDRZYNSKI, NICOLE MD	8/25/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	186390	18	Ophthalmology	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
156909	Fee-for-Service	1114092186	1114092186	1	1	JAJODIA, PRAHALAD B MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56084	66	Emergency Medicine (Urgent Care)	0	In state provider	DIGESTIVE AND LIVER DISE	6137 N THESTA ST	STE 103	FRESNO	CA	93710	8605	10	06019	36.82557364	-119.783138	Fresno County
156936	Fee-for-Service	1861196768	1861196768	1	1	JADHEL TRANSPORTATION	2/23/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	23328 OLIVE WOOD PLAZA D	C	MORENO VALLEY	CA	92553	5247	33	06065	33.94012202	-117.254024	Riverside County
156968	Fee-for-Service	1780144303	1780144303	1	1	JWCH INSTITUTE INC	4/15/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2151 E PALMDALE	None	PALMDALE	CA	93550	4037	19	06037	34.58013142	-118.0898273	Los Angeles County
157065	Fee-for-Service	1154541423	1154541423	1	1	JOSHI, NITIN D MD	6/8/2010	207R00000X	NA	Other	026	PHYSICIANS	93287	68	Hematology	0	In state provider	None	20055 LAKE CHABOT RD	STE 130	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
157155	Fee-for-Service	1295883148	1295883148	1	1	JARJOUR, SAMIH MD	3/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51867	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
157166	Fee-for-Service	1598059644	1598059644	1	1	JAMALI, LAYLI MD	10/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141828	77	Infectious Disease	0	In state provider	None	2250 HAYES ST	SUITE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
157195	Fee-for-Service	1114092186	1114092186	1	1	JAJODIA, PRAHALAD B MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56084	41	Internal Medicine	0	In state provider	DIGESTIVE AND LIVER DISE	6137 N THESTA ST	STE 103	FRESNO	CA	93710	8605	10	06019	36.82557364	-119.783138	Fresno County
157218	Fee-for-Service	1679501522	1679501522	1	1	JOSEPH NGUYEN 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	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
157248	Fee-for-Service	1649243528	1649243528	1	1	JORDAN, REBECCA S MD	6/26/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	53618	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	7600 HOSPITAL DR	STE G	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
157249	Fee-for-Service	1235339938	1235339938	1	1	JUNG-WU, SANDY Y MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101447	03	Allergy	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
157252	Fee-for-Service	1518903558	1518903558	1	1	JENNIFER,BURTNER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	0000	00	None	47.052801	-122.847462	Thurston County
157282	Fee-for-Service	1205820842	1205820842	1	1	JOHNSON, MICHEAL B DO	6/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	9408	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
157352	Fee-for-Service	1154541423	1154541423	1	1	JOSHI, NITIN D MD	6/8/2010	207R00000X	NA	Other	026	PHYSICIANS	93287	78	Neoplastic Diseases/Oncology	0	In state provider	None	20055 LAKE CHABOT RD	STE 130	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
157438	Fee-for-Service	1598847576	1598847576	1	1	JOHN E JONES MD	8/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
157480	Fee-for-Service	1861601809	1861601809	1	1	JOHNSON, JULIE M MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140761	20	Orthopedic Surgery	0	In state provider	None	39000 BOB HOPE DRIVE	HARRY AND DIANE RINKER B	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
157528	Fee-for-Service	1376613851	1376613851	1	1	JOSEPH EDWARD PODANY, JR., M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	166 S 5TH STREET	None	MONTPELIER	ID	83254	0000	00	None	42.31631981	-111.3008075	Bear Lake County
157531	Fee-for-Service	1619025640	1619025640	1	1	JALALI, MAHNAZ MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92673	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
157674	Fee-for-Service	1669891727	1669891727	1	1	JORGE, PAOLO G MD	11/19/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	144454	None	None	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
157733	Fee-for-Service	1124298575	1124298575	1	1	JAVAHERI, MICHAEL MD	9/19/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	94767	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
157890	Fee-for-Service	1336806439	1336806439	1	1	JEROME NICHOLAS JEW	6/14/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	919 CLAY ST	None	SAN FRANCISCO	CA	94108	1520	38	06075	37.79398652	-122.4083496	San Francisco County
157892	Fee-for-Service	1902268360	1902268360	1	1	JACKSON, JORDAN MD	8/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	153292	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
157979	Fee-for-Service	1194840694	1194840694	1	1	JANMOHAMED, MUNIR S MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90689	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
158149	Fee-for-Service	1467894378	1467894378	1	1	JAMES SLOAN OPTOMETRY, APC	10/2/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13321 MOORPARK STREET	None	SHERMAN OAKS	CA	91423	0000	19	06037	34.15038752	-118.423125	Los Angeles County
158259	Fee-for-Service	1487609707	1487609707	1	1	JANG, TIMOTHY B MD	11/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83407	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
158267	Fee-for-Service	1194840694	1194840694	1	1	JANMOHAMED, MUNIR S MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90689	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
158277	Fee-for-Service	1861633802	1861633802	1	1	JWALA, SUSHMA MD	1/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152762	15	Obstetrics (D.O. only)	0	In state provider	None	900 EAST HAMILTON AVENUE	SUITE 220	CAMPBELL	CA	95008	0665	43	06085	37.29428651	-121.934403	Santa Clara County
158286	Fee-for-Service	1487183364	1487183364	1	1	JAVIDI, SAEED MD	5/16/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171480	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
158314	Fee-for-Service	1740465541	1740465541	1	1	JENSEN, DEXTER A MD	1/12/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67960	-	NOT APPLICABLE	0	In state provider	None	9465 FARNHAM STREET	None	SAN DIEGO	CA	92123	1308	37	06073	32.83275552	-117.1246095	San Diego County
158377	Fee-for-Service	1003507963	1003507963	1	1	JSINGHMD INC	6/2/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8711 VENICE BLVD	None	LOS ANGELES	CA	90034	3216	19	06037	34.03259874	-118.3827656	Los Angeles County
158378	Fee-for-Service	1578189429	1578189429	1	1	JOSEPH, LAUREN M MD	8/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
158391	Fee-for-Service	1902949670	1902949670	1	1	JOHNSON, JENNIFER NP	6/13/2022	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
158392	Fee-for-Service	1982137212	1982137212	1	1	JAMAL, AMANDA L MD	8/27/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159540	08	Family Practice	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
158448	Fee-for-Service	1962040063	1962040063	1	1	JANETS ENTERPRISE INC	5/21/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10771 LILAC AVE	None	LOMA LINDA	CA	92354	2316	36	06071	34.05801825	-117.2518286	San Bernardino County
158496	Fee-for-Service	1457391526	1457391526	1	1	JONATHAN S. MOULTON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
158559	Fee-for-Service	1235391624	1235391624	1	2	JASON KELLOGG M.D. INC	11/4/2022	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
158573	Fee-for-Service	1235596099	1235596099	1	1	JACOBSEN, KELSEY L	12/19/2016	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
158615	Fee-for-Service	1194710673	1194710673	1	1	JAMESON, HARRY D JR MD	3/15/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	65571	40	Pediatrics	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
158633	Fee-for-Service	1295407856	1295407856	1	1	JEANTY, SYDNIE NP	1/10/2024	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
158635	Fee-for-Service	1003916727	1003916727	1	1	JAMAL, MOHAMMAD M MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46078	10	Gastroenterology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
158723	Fee-for-Service	1891767943	1891767943	1	1	JON C CLYDE MD	12/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
158731	Fee-for-Service	1184777120	1184777120	1	1	JONES, STEPHANIE A DO	9/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11813	02	General Surgery	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
158733	Fee-for-Service	1780815522	1780815522	1	1	JOHNSTON, RYAN M DO	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12236	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
158846	Fee-for-Service	1235391624	1235391624	1	2	JASON KELLOGG M.D. INC	7/26/2023	2084N0400X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
158901	Fee-for-Service	1194710673	1194710673	1	1	JAMESON, HARRY D JR MD	3/15/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	65571	41	Internal Medicine	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
158988	Fee-for-Service	1720529068	1720529068	1	1	JIN, JOSEPH MD	8/16/2021	390200000X	NA	Other	026	PHYSICIANS	157769	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
159006	Fee-for-Service	1134229347	1134229347	1	1	JOHNSTONE, MARGARET A NP	4/7/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1450 TREAT BLVD	SUITE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
159107	Fee-for-Service	1720139892	1720139892	1	1	JOSHUA FRANK MD	6/25/2017	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
159268	Fee-for-Service	1376591925	1376591925	1	1	JAHED, NAVID MD	7/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75716	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
159292	Fee-for-Service	1699958868	1699958868	1	1	JWCH INSTITUTE, INC	5/15/2006	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	BELL GARDENS COMM HEALTH	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	19	06037	33.96992365	-118.1629712	Los Angeles County
159371	Fee-for-Service	1265459812	1265459812	1	1	JANE H. POLLNER MD	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
159386	Fee-for-Service	1497802318	1497802318	1	1	JACOBS, DEAN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91057	40	Pediatrics	0	In state provider	None	455 SO MAIN STREET	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
159414	Fee-for-Service	1114022738	1114022738	1	1	JAFRI, RACHNA A MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51987	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
159428	Fee-for-Service	1922571819	1922571819	1	1	JONES, KELLEY RCP	8/30/2020	2279E1000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
159454	Fee-for-Service	1649366410	1649366410	1	1	JOE, STEVEN H MD	10/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5951	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
159524	Fee-for-Service	1972114635	1972114635	1	1	JOVES, JEREMY PSYD	5/31/2024	103T00000X	NA	Mental Health Outpatient Services	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
159540	Fee-for-Service	1326571779	1326571779	1	1	JEFFERY MACK M.D	12/14/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 SCHNEIDER DR	None	MALVERN	AR	72104	4811	00	None	34.358751	-92.785941	Hot Spring County
159711	Fee-for-Service	1306036157	1306036157	1	1	JONES, JASON A PHD	8/20/2013	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
159716	Fee-for-Service	1881621175	1881621175	1	1	JENSEN, DAVID F MD	9/30/1986	207ZP0101X	NA	Other	026	PHYSICIANS	54073	22	Pathology (M.D. only)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
159759	Fee-for-Service	1992586937	1992586937	1	1	JIMENEZ, CINDY AU	12/18/2023	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
159819	Fee-for-Service	1245206457	1245206457	1	1	JOSWIG, BILL C MD	12/31/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28454	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3921 WARING RD	# C	OCEANSIDE	CA	92056	4456	37	06073	33.18776771	-117.2893136	San Diego County
160010	Fee-for-Service	1144223793	1144223793	1	1	JENSEN, STEVE C DPM	7/31/1980	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	780 DELNERO DR	None	SONORA	CA	95370	5223	55	06109	37.97851202	-120.3702207	Tuolumne County
160162	Fee-for-Service	1982876322	1982876322	1	1	JOY CARINO KIMPO FAMILY	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	1001 MAIN ST	None	DELANO	CA	93215	1731	15	06029	35.76932624	-119.245737	Kern County
160209	Fee-for-Service	1275952483	1275952483	1	1	JOHNSON, KENNETH S MD AMC	10/17/2014	207L00000X	NA	Other	026	PHYSICIANS	43322	05	Anesthesiology	0	In state provider	None	14900 E IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
160243	Fee-for-Service	1235606823	1235606823	1	1	JOHN MUIR PHYSICIANS PC	10/31/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	11 ALTARINDA RD	None	ORINDA	CA	94563	2602	07	06013	37.8829129	-122.1839574	Contra Costa County
160329	Fee-for-Service	1356607931	1356607931	1	1	JOHANNA CLARA NESSE NP	8/13/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
160360	Fee-for-Service	1922150531	1922150531	1	1	JAWAUN M. LEWIS D.O.	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 N PORTER AVE	None	NORMAN	OK	73071	6404	00	None	35.23022019	-97.44110859	Cleveland County
160445	Fee-for-Service	1275501629	1275501629	1	2	JONES, ROBERT C MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42790	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
160562	Fee-for-Service	1609920305	1609920305	1	1	J GELT CORPORATION	11/27/2000	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CASA PACIFICA ADHC	1424 30TH ST	STE C	SAN DIEGO	CA	92154	3417	37	06073	32.57104918	-117.0672037	San Diego County
160569	Fee-for-Service	1497709596	1497709596	1	1	JASON N. VIEDER, 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	19401 HUBBARD DR	None	DEARBORN	MI	48126	2641	00	None	42.32129317	-83.22821984	Wayne County
160628	Fee-for-Service	1144281114	1144281114	1	1	JOHANSEN,BART MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 N TRIUMPH BLVD	None	LEHI	UT	84043	4999	00	None	40.42593191	-111.8802049	Utah County
160690	Fee-for-Service	1225614993	1225614993	1	1	JAMES, DAVID MD	4/19/2024	390200000X	NA	Other	026	PHYSICIANS	191470	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
160732	Fee-for-Service	1275501629	1275501629	1	2	JONES, ROBERT C MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42790	41	Internal Medicine	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
160893	Fee-for-Service	1902068208	1902068208	1	1	JIH, JANE MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121062	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
160942	Fee-for-Service	1437808870	1437808870	1	1	JACKSON, JOSEPH H MD	3/13/2025	207P00000X	NA	Other	026	PHYSICIANS	187890	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
160984	Fee-for-Service	1790172419	1790172419	1	1	JEN, DENISE DO	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14955	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
161033	Fee-for-Service	1205152220	1205152220	1	1	JABER, NOOR M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2215 TRUXTUN AVENUE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
161047	Fee-for-Service	1295996460	1295996460	1	1	JAJU, ALOK MD	6/12/2024	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
161125	Fee-for-Service	1407808058	1407808058	1	9	JWCH INSTITUTE INC	12/12/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1774 ZONAL AVENUE	BUILDING E	LOS ANGELES	CA	90033	1064	19	06037	34.06160288	-118.2099956	Los Angeles County
161251	Fee-for-Service	1073810636	1073810636	1	1	JING, LING DO	12/17/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	14260	39	Preventive (M.D. only)	0	In state provider	None	5575 RUFFIN RD	SUITE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
161413	Fee-for-Service	1407808058	1407808058	1	9	JWCH INSTITUTE INC	12/12/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1774 ZONAL AVENUE	BUILDING E	LOS ANGELES	CA	90033	1064	19	06037	34.06160288	-118.2099956	Los Angeles County
161479	Fee-for-Service	1427100973	1427100973	1	2	JAGJIT SINGH, M.D., INC.	6/1/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	None	None	0	In state provider	None	2216 N CALIFORNIA ST	STE A	STOCKTON	CA	95204	5533	39	06077	37.97386974	-121.2903465	San Joaquin County
161493	Fee-for-Service	1306996194	1306996194	1	1	JOHNS, ROBERT A OD	1/1/1984	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 COLORADO AVE	None	TURLOCK	CA	95380	2749	50	06099	37.50234753	-120.8353005	Stanislaus County
161813	Fee-for-Service	1598829350	1598829350	1	1	JWCH INSTITUTE, INC	1/15/2025	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
161859	Fee-for-Service	1285703215	1285703215	1	1	JAMES C. HAYES, M.D.	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
161884	Fee-for-Service	1750621918	1750621918	1	1	JARA, ERICA S LCSW	8/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
161892	Fee-for-Service	1083142582	1083142582	1	1	JAYAKAR, MARISA Y MD	9/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157257	08	Family Practice	0	In state provider	None	455 OCONNOR DR	SUITE 210	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
161933	Fee-for-Service	1083991293	1083991293	1	1	JOHNSON-YOUNG, JILL A LCSW	12/27/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
161941	Fee-for-Service	1134195977	1134195977	1	1	JAHNKE, ERIC W MD	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	40086	10	Gastroenterology (M.D. only)	0	In state provider	None	1311 SOUTH MILLER ST	STE 101	SANTA MARIA	CA	93454	6900	42	06083	34.93818375	-120.4316485	Santa Barbara County
161960	Fee-for-Service	1922402700	1922402700	1	2	JACOBSON, CATHLEEN LMFT	12/7/2023	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	511 CLIFF DR	None	NEWPORT BEACH	CA	92663	5810	30	06059	33.61790338	-117.9101392	Orange County
162101	Fee-for-Service	1598829350	1598829350	1	1	JWCH INSTITUTE, INC	6/29/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
162132	Fee-for-Service	1659994739	1659994739	1	1	JEY NEURO CENTER, INC	6/21/2021	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3400 CALLOWAY DR,	STE 100	BAKERSFIELD	CA	93312	2513	15	06029	35.39110123	-119.1097878	Kern County
162145	Fee-for-Service	1174793814	1174793814	1	1	JABI, FERAAS	7/14/2020	207U00000X	NA	Other	026	PHYSICIANS	168191	30	Radiology	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 100	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
162187	Fee-for-Service	1598829350	1598829350	1	12	JWCH INSTITUTE, INC	5/16/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	45124 10TH STREET W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
162213	Fee-for-Service	1598829350	1598829350	1	7	JWCH INSTITUTE, INC	6/7/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	320 N MADISON AVE	STE A	LOS ANGELES	CA	90004	3791	19	06037	34.07696749	-118.2891433	Los Angeles County
162233	Fee-for-Service	1134195977	1134195977	1	1	JAHNKE, ERIC W MD	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	40086	41	Internal Medicine	0	In state provider	None	1311 SOUTH MILLER ST	STE 101	SANTA MARIA	CA	93454	6900	42	06083	34.93818375	-120.4316485	Santa Barbara County
162248	Fee-for-Service	1174917207	1174917207	1	1	JENG, JACK Y MD	6/11/2019	207L00000X	NA	Other	026	PHYSICIANS	148416	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
162253	Fee-for-Service	1528055407	1528055407	2	1	JCH PHARMACY LA, INC.	5/12/2023	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
162260	Fee-for-Service	1225367915	1225367915	1	1	JUNG, HOWARD MD	2/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108985	14	Neurological 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
162302	Fee-for-Service	1780689778	1780689778	1	1	JASON STOANE 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	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	0000	00	None	48.77211992	-122.473101	Whatcom County
162316	Fee-for-Service	1679969026	1679969026	1	1	JAISON, BERLY A MD	9/6/2018	207P00000X	NA	Other	026	PHYSICIANS	157781	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
162352	Fee-for-Service	1699858464	1699858464	1	1	JUNGKUNTZ, TODD M PHD	8/6/2014	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
162367	Fee-for-Service	1013580802	1013580802	1	1	JUN, EUNJI	10/12/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5270 ELVAS AVE	None	SACRAMENTO	CA	95819	2332	34	06067	38.57603261	-121.4349541	Sacramento County
162372	Fee-for-Service	1629399092	1629399092	1	1	JOHN, TAMI D MD	7/18/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	118535	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
162382	Fee-for-Service	1245256064	1245256064	1	1	JANSARI, BHAVESH I MD	11/16/2023	207R00000X	NA	Other	026	PHYSICIANS	94263	None	None	0	In state provider	None	10000 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4020	19	06037	33.94833058	-118.1166411	Los Angeles County
162392	Fee-for-Service	1598829350	1598829350	1	1	JWCH INSTITUTE, INC	6/29/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
162463	Fee-for-Service	1174800064	1174800064	1	1	JACKSON, MARGARET K	1/13/2014	No Taxonomy Provided	NA	None	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
162465	Fee-for-Service	1922495514	1922495514	1	1	JIANG, BAIJIA MD	7/7/2021	207R00000X	NA	Other	026	PHYSICIANS	147042	None	None	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
162474	Fee-for-Service	1598829350	1598829350	1	12	JWCH INSTITUTE, INC	11/14/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	45124 10TH STREET W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
162475	Fee-for-Service	1639628407	1639628407	1	1	JESSICA J GREEN PNP	8/22/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
162502	Fee-for-Service	1598829350	1598829350	1	7	JWCH INSTITUTE, INC	6/7/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	320 N MADISON AVE	STE A	LOS ANGELES	CA	90004	3791	19	06037	34.07696749	-118.2891433	Los Angeles County
162527	Fee-for-Service	1568555845	1568555845	1	1	JACKSON, LENLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87877	None	None	0	In state provider	DOVE FAMILY MEDICINE	240 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
162549	Fee-for-Service	1396762332	1396762332	1	1	JACOBO, GRACIELA C	4/1/1994	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	JACOBO PHYSICAL THERAPY	2828 H ST	STE F	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
162573	Fee-for-Service	1962990036	1962990036	1	1	JAHANGIRI, WALI MD	10/30/2023	261QX0100X	NA	Other	026	PHYSICIANS	187807	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
162576	Fee-for-Service	1891157392	1891157392	1	1	JAFFE, GILAD M MD	3/29/2022	207R00000X	NA	Other	026	PHYSICIANS	150905	None	None	0	In state provider	None	326 SANTA FE DRIVE	100	ENCINITAS	CA	92024	5138	37	06073	33.040332	-117.285102	San Diego County
162581	Fee-for-Service	1154401982	1154401982	1	1	JILDA N VARGUS-ADAMS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
162717	Fee-for-Service	1720069859	1720069859	1	1	JANES, WILLIAM W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SOUTH TEXAS PM&R GRP INC	5101 MEDICAL DR	None	SAN ANTONIO	TX	78229	0000	00	None	29.514015	-98.5868955	Bexar County
162752	Fee-for-Service	1255395331	1255395331	1	1	JOHNSON, DAVID S MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65870	36	Psychiatry	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
162763	Fee-for-Service	1598829350	1598829350	1	12	JWCH INSTITUTE, INC	5/16/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	45124 10TH STREET W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
162790	Fee-for-Service	1780262246	1780262246	1	1	JACKSON, JEREMY L MD	8/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	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
162832	Fee-for-Service	1861987570	1861987570	1	1	JENO, MARY E MD	1/23/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	186019	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
162850	Fee-for-Service	1689060063	1689060063	1	1	JACKSON, DANA L DO	9/19/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14119	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
162920	Fee-for-Service	1790719292	1790719292	1	1	JANJUA, NAZLI MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93806	13	Neurology (M.D. only)	0	In state provider	None	1798 N GAREY AVE	2ND FLOOR CATH LAB	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
163020	Fee-for-Service	1063932275	1063932275	1	1	JJLM PHARMACEUTICALS	9/8/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	396 S MAIN ST	STE 102	ORANGE	CA	92868	3845	30	06059	33.78244003	-117.8673363	Orange County
163040	Fee-for-Service	1518243542	1518243542	1	1	JAY, VIVIAN S NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
163043	Fee-for-Service	1962745869	1962745869	1	1	JOSHUA ERIC RIDER	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
163049	Fee-for-Service	1447576699	1447576699	1	1	JP PHARMACY, INC	9/3/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	JP PHARMACY, INC	9188 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	4804	37	06073	32.91725184	-117.125891	San Diego County
163078	Fee-for-Service	1184711236	1184711236	1	1	JAY M. KINCANNON	1/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
163099	Fee-for-Service	1285686261	1285686261	1	1	JENNELLE MARCEREAU MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
163105	Fee-for-Service	1598829350	1598829350	1	4	JWCH INSTITUTE, INC	9/23/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14371 CLARK AVE	None	BELLFLOWER	CA	90706	2901	19	06037	33.90323754	-118.134141	Los Angeles County
163122	Fee-for-Service	1912401589	1912401589	1	1	JOHNSTON, BRIAN J	2/26/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
163250	Fee-for-Service	1518435437	1518435437	1	1	JACKSON, VICTORIA L NP	12/17/2018	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
163347	Fee-for-Service	1861623175	1861623175	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
163362	Fee-for-Service	1194117820	1194117820	1	1	JIANG, FEI	7/11/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE AVE	None	SUNNYVALE	CA	94086	6125	43	06085	37.36886669	-122.0316101	Santa Clara County
163377	Fee-for-Service	1215382296	1215382296	1	1	JOHNSON, DANIEL L	4/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144747	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3033 WEST ORANGE AVE	None	ORANGE	CA	92804	3183	30	06059	33.82476552	-117.994914	Orange
163391	Fee-for-Service	1598829350	1598829350	1	4	JWCH INSTITUTE, INC	9/23/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14371 CLARK AVE	None	BELLFLOWER	CA	90706	2901	19	06037	33.90323754	-118.134141	Los Angeles County
163446	Fee-for-Service	1558145888	1558145888	1	1	JANSEN, MELANIE	11/29/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
163449	Fee-for-Service	1730836867	1730836867	1	1	JINGWA INC	10/13/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27680 LOYOLA AVENUE	None	HAYWARD	CA	94545	4263	01	06001	37.62700701	-122.0934986	Alameda County
163467	Fee-for-Service	1871679373	1871679373	1	1	JAIN, VIVEK MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73069	13	Neurology (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
163472	Fee-for-Service	1760761118	1760761118	1	1	JOHN, SALU E MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127463	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
163542	Fee-for-Service	1356421903	1356421903	1	1	JASPER, IRINA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73109	41	Internal Medicine	0	In state provider	None	960 E GREEN ST	STE 286	PASADENA	CA	91106	2420	19	06037	34.14451994	-118.1301695	Los Angeles County
163557	Fee-for-Service	1679704340	1679704340	1	1	JAHANGIRI, NOOSHIN MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113619	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
163564	Fee-for-Service	1346668696	1346668696	1	1	JAMZADEH, ASHA E MD	9/16/2019	208800000X	NA	Other	026	PHYSICIANS	159643	34	Urology and Urological Surgery	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
163586	Fee-for-Service	1083802235	1083802235	1	1	JUHASZ, JON J MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
163605	Fee-for-Service	1457739229	1457739229	1	2	JENDUSA, MICHAEL F MD	3/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	169436	-	NOT APPLICABLE	0	In state provider	None	3355 MISSION AVE	STE 234-237 & 239	OCEANSIDE	CA	92058	1326	37	06073	33.21762263	-117.3420186	San Diego County
163634	Fee-for-Service	1861623175	1861623175	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
163718	Fee-for-Service	1326572454	1326572454	1	1	JOHNSON, KAYLA MD	9/13/2023	207P00000X	NA	Other	026	PHYSICIANS	182759	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
163793	Fee-for-Service	1316013865	1316013865	1	1	JONES, NEIL F MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56401	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	RM 140	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
163800	Fee-for-Service	1174813349	1174813349	1	1	JOSEPH, LINDA M MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130610	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
163885	Fee-for-Service	1326580044	1326580044	1	1	JUBRAN, JUMANA LMFT	8/20/2024	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
163922	Fee-for-Service	1497780571	1497780571	1	1	JACOB, KATHERINE N MD	10/30/2007	207RE0101X	NA	Endocrinology	026	PHYSICIANS	97880	67	Endocrinology	0	In state provider	None	1500 S CENTRAL AVE	STE 326	GLENDALE	CA	91204	2556	19	06037	34.12736888	-118.257777	Los Angeles County
163924	Fee-for-Service	1861623175	1861623175	1	1	JABBERGYM, INC.	2/21/2020	224Z00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
163939	Fee-for-Service	1407308844	1407308844	1	1	JIMENEZ, IVETTE A NP	5/28/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
163942	Fee-for-Service	1881258903	1881258903	1	1	JAVAID, NAILA K MD	12/8/2022	207R00000X	NA	Other	026	PHYSICIANS	178315	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
164051	Fee-for-Service	1942818356	1942818356	1	1	JAMERSON, KRISTIAN S NP	2/18/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2475 N GAREY AVE	None	POMONA	CA	91767	2139	19	06037	34.091714	-117.7487264	Los Angeles County
164055	Fee-for-Service	1467470468	1467470468	1	1	JUE, DAVID M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61676	41	Internal Medicine	0	In state provider	None	3230 BEARD RD	None	NAPA	CA	94558	3673	28	06055	38.3216968	-122.2953847	Napa County
164119	Fee-for-Service	1689490815	1689490815	1	1	JEONG, JENNIFER J NP	3/17/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
164176	Fee-for-Service	1275557282	1275557282	1	1	JUVE, JOHN CRNA	7/1/2003	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
164213	Fee-for-Service	1013913490	1013913490	1	1	JOSHI, AKASH C MD	1/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187309	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
164228	Fee-for-Service	1770509002	1770509002	1	1	JACOBSON, MARK E MD	7/28/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	43631	18	Ophthalmology	0	In state provider	None	380 TESCONI CT	None	SANTA ROSA	CA	95401	4653	49	06097	38.447631	-122.7345885	Sonoma County
164230	Fee-for-Service	1508900473	1508900473	1	1	JULIA JONES	8/29/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	405 W COUNTRY CLUB RD	None	ROSWELL	NM	88201	5209	00	None	33.42332853	-104.5286841	Chaves County
164240	Fee-for-Service	1114145257	1114145257	1	1	JOHNSTON, ELIZABETH A MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125115	02	General Surgery	0	In state provider	None	2809 OLIVE HWY	STE 220	OROVILLE	CA	95966	6118	04	06007	39.50386798	-121.5410203	Butte County
164257	Fee-for-Service	1033342829	1033342829	1	1	JOHN V CROWDER JR MD INC	6/16/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33682	18	Ophthalmology	0	In state provider	None	160 GREEN VALLEY RD	STE 202	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
164276	Fee-for-Service	1578566998	1578566998	1	1	JHANGIANI, HARESH S MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38872	78	Neoplastic Diseases/Oncology	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
164279	Fee-for-Service	1629006796	1629006796	1	1	JENDERS, ROBERT A MD	7/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86614	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
164444	Fee-for-Service	1023175114	1023175114	1	1	JORDAN, MELANIE L CNM	5/18/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	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
164545	Fee-for-Service	1306342084	1306342084	1	1	JACKSON, TYLER R	8/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
164564	Fee-for-Service	1578566998	1578566998	1	1	JHANGIANI, HARESH S MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38872	41	Internal Medicine	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
164615	Fee-for-Service	1972261709	1972261709	1	1	JAMES F YUSUF Q ERSKINE DO I	12/8/2021	204D00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ER	506 S MAIN ST	None	SEBASTOPOL	CA	95472	4261	49	06097	38.39799405	-122.8220018	Sonoma County
164642	Fee-for-Service	1790909950	1790909950	1	1	JASON HOLDER	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
164683	Fee-for-Service	1518988005	1518988005	1	1	JOHNSON, VANCE Z MD	9/25/2020	208VP0014X	NA	Other	026	PHYSICIANS	61529	25	Physical Medicine and Rehabilitation	0	In state provider	None	1901 W LUGONIA AVE	SUITE 230	REDLANDS	CA	92374	9703	36	06071	34.07027851	-117.218421	San Bernardino County
164819	Fee-for-Service	1952469272	1952469272	1	1	JYOTHEESWARAN, SITARAMAN	6/22/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62578	10	Gastroenterology (M.D. only)	0	In state provider	None	520 N PROSPECT AVE	STE 304	REDONDO BEACH	CA	90277	3043	19	06037	33.8529819	-118.3802954	Los Angeles County
164835	Fee-for-Service	1306281027	1306281027	1	1	JOHNSON, RYAN A	5/20/2014	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4190 BONITA ROAD	SUITE 104	BONITA	CA	91902	1330	37	06073	32.65992404	-117.0374929	San Diego County
164849	Fee-for-Service	1578566998	1578566998	1	1	JHANGIANI, HARESH S MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38872	68	Hematology	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
164881	Fee-for-Service	1194768416	1194768416	1	1	JOHNSON, RICHARD J MD	11/1/2018	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
165107	Fee-for-Service	1952469272	1952469272	1	1	JYOTHEESWARAN, SITARAMAN	6/22/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62578	41	Internal Medicine	0	In state provider	None	520 N PROSPECT AVE	STE 304	REDONDO BEACH	CA	90277	3043	19	06037	33.8529819	-118.3802954	Los Angeles County
165171	Fee-for-Service	1194768416	1194768416	1	1	JOHNSON, RICHARD J MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
165226	Fee-for-Service	1104908375	1104908375	1	1	JST INC	10/1/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3500 E COLORADO BLVD	STE 108	PASADENA	CA	91107	3832	19	06037	34.14623048	-118.078119	Los Angeles County
165287	Fee-for-Service	1144250184	1144250184	1	1	JAPRA, ROMESH K MD INC	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	32218	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1900 MOWRY AVE	STE 201	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
165289	Fee-for-Service	1932743515	1932743515	1	1	JAFFE, JACOB H PT	5/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
165400	Fee-for-Service	1528325925	1528325925	1	1	JUN, DALE MD	6/5/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	127465	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
165403	Fee-for-Service	1972740314	1972740314	1	1	JUAREZ, ELIZABETH PT	6/30/2020	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
165414	Fee-for-Service	1215975776	1215975776	1	1	JUDD, SARAH A MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54689	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
165433	Fee-for-Service	1639332315	1639332315	1	1	JOHNSON, EBUNOLUWA O MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112523	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
165436	Fee-for-Service	1609194323	1609194323	1	1	JAVIDAN, POOYA MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136095	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
165483	Fee-for-Service	1730307885	1730307885	1	1	JESTER, ROBERT W	1/26/1992	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	532 E FLORIDA AVE	None	HEMET	CA	92543	4334	33	06065	33.7476183	-116.9665293	Riverside County
165557	Fee-for-Service	1265838064	1265838064	1	2	JACOBS, LAURA LMFT	5/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1024 IRON POINT RD	1026	FOLSOM	CA	95630	8013	34	06067	38.643246	-121.1794245	Sacramento County
165644	Fee-for-Service	1437177839	1437177839	1	1	JAMES MICHAEL MATTHEWS, 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	11820 SW KING JAMES PL	STE 30	KING CITY	OR	97224	2481	00	None	45.40167247	-122.7991815	Washington County
165674	Fee-for-Service	1528325925	1528325925	1	1	JUN, DALE MD	6/5/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	127465	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
165685	Fee-for-Service	1548461080	1548461080	1	1	JORDAN, AMANDA R MD	11/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
165723	Fee-for-Service	1104877315	1104877315	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC	1720 CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.04925	-118.2177405	Los Angeles County
165730	Fee-for-Service	MSS00026F	None	1	1	JEWISH FAMILY &	3/1/1999	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CHILDREN'S SERVICES	600 5TH AVE	None	SAN RAFAEL	CA	94901	3348	21	06041	37.97305823	-122.520687	Marin County
165744	Fee-for-Service	1396931788	1396931788	1	1	JACOBI, JANET B 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
165974	Fee-for-Service	1124041066	1124041066	1	1	JACOBS, BETSY A MD	4/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91856	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
166052	Fee-for-Service	1184689085	1184689085	1	1	J & K ORTHOPEDICS INC	1/22/2001	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 E BONITA AVE	None	POMONA	CA	91767	1926	19	06037	34.09618648	-117.7443519	Los Angeles County
166091	Fee-for-Service	1972831287	1972831287	1	1	JEFFCOACH, DAVID R MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142245	89	Surgery-Traumatic	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
166094	Fee-for-Service	1104844737	1104844737	1	1	JOHNSON, SUSAN N LMFT	6/8/2020	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
166100	Fee-for-Service	1255759692	1255759692	1	1	JOHNSON, RENEE C MD	10/22/2020	207P00000X	NA	Other	026	PHYSICIANS	-	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
166102	Fee-for-Service	1336108547	1336108547	1	1	JERNIGAN, ONNA R MD	6/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	880 ALDER AVE	None	INCLINE VILLAGE	NV	89451	8335	00	None	39.25092003	-119.9543846	Washoe County
166197	Fee-for-Service	1114173721	1114173721	1	1	JUN, JAE H MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106794	84	Surgery-Head and Neck	0	In state provider	None	7900 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.4686595	-121.4227378	Sacramento County
166486	Fee-for-Service	1215253059	1215253059	1	1	JI, WANG MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125738	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	SUITE 100	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
166566	Fee-for-Service	1235606823	1235606823	1	3	JOHN MUIR PHYSICIANS PC	8/10/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1477 GROVE ST	None	SAN FRANCISCO	CA	94117	1421	38	06075	37.7755254	-122.4408282	San Francisco County
166708	Fee-for-Service	1235217142	1235217142	1	1	JONDREAU, MICHELLE M MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65576	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
166811	Fee-for-Service	1104834555	1104834555	1	1	JACKSON, CASEY G MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89364	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
166812	Fee-for-Service	1376766238	1376766238	1	1	J COLE RECOVERY HOMES, INC	7/26/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1408 A ST	None	ANTIOCH	CA	94509	2331	07	06013	38.007756	-121.8060465	Contra Costa County
166949	Fee-for-Service	1912934910	1912934910	1	1	JOANNA C NACOPOULOS 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	3341 SOLUTIONS CTR	None	CHICAGO	IL	60677	3003	00	None	0	0	None
166950	Fee-for-Service	1811383011	1811383011	1	1	JANG, EUGENE S MD	9/23/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	173645	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
166969	Fee-for-Service	1629083407	1629083407	1	1	JURISICH, PETER D MD	8/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8542	41	Internal Medicine	0	In state provider	None	3941 J ST	STE 260	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
167071	Fee-for-Service	1023379369	1023379369	1	1	JUNGE, TRAVIS J MD	9/3/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	183962	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	101B 102B 104B 106B 108B	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
167074	Fee-for-Service	1487750873	1487750873	1	1	JOHN DEGUIRE MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
167084	Fee-for-Service	1265454706	1265454706	1	1	JOHNSON, IAN R	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75719	None	None	0	In state provider	None	1930 DEL PASO RD	STE 120	SACRAMENTO	CA	95834	7717	34	06067	38.654694	-121.504968	Sacramento County
167090	Fee-for-Service	1801139175	1801139175	1	1	JACOB, GABRIEL MD A MEDICAL	7/2/2013	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2510 DOUGLAS	SUITE #400	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
167179	Fee-for-Service	1881949972	1881949972	1	1	JONES, DORIS LMFT	6/21/2024	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
167201	Fee-for-Service	1871729871	1871729871	1	1	JULIE VU	1/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 W TAYLOR ST	None	CHICAGO	IL	60612	7232	00	None	41.8692353	-87.67061005	Cook County
167248	Fee-for-Service	1710758735	1710758735	1	1	JEFFERS, MATTHEW D PT	4/16/2024	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
167367	Fee-for-Service	1609868470	1609868470	1	1	JACQUES, THOMAS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1650 BEAM AVE	STE 200	SAINT PAUL	MN	55109	1147	00	None	45.02792493	-93.03090563	Ramsey County
167369	Fee-for-Service	1063983468	1063983468	1	1	JOSEPH, JOHN E LMFT	12/28/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8788 ELK GROVE BLVD	STE M	ELK GROVE	CA	95624	1768	34	06067	38.408382	-121.3770645	Sacramento County
167370	Fee-for-Service	1902843931	1902843931	1	1	JAMES L ORFORD M.D.	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5169 S COTTONWOOD ST	STE 520	MURRAY	UT	84107	5701	00	None	40.658895	-111.891447	Salt Lake County
167381	Fee-for-Service	1801139175	1801139175	1	1	JACOB, GABRIEL MD A MEDICAL	7/2/2013	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CORPORATION	2510 DOUGLAS	SUITE #400	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
167456	Fee-for-Service	1003186602	1003186602	1	1	JOHNSON, KIMBERLY T R LCSW	12/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
167526	Fee-for-Service	1770988370	1770988370	1	1	JWCH INSTITUTE INC	5/12/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	19	06037	33.93782301	-118.1288691	Los Angeles County
167622	Fee-for-Service	1609358373	1609358373	1	1	JOHAL-MORALES, JACQUELINE M	6/27/2024	390200000X	NA	Other	026	PHYSICIANS	183301	08	Family Practice	0	In state provider	D	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
167651	Fee-for-Service	1588778971	1588778971	1	1	JANSEN, CHARLES A	12/16/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4000 TYLER ST	None	RIVERSIDE	CA	92503	3402	33	06065	33.91564903	-117.464488	Riverside County
167653	Fee-for-Service	1558542209	1558542209	1	1	JONAS, BRIAN A MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105278	41	Internal Medicine	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
167656	Fee-for-Service	1659380624	1659380624	1	1	JULIE ANN FOX MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2675 W TAYLORSVILLE BLVD	None	TAYLORSVILLE BLVD	UT	84129	2208	00	None	40.65438556	-111.9571398	Salt Lake County
167671	Fee-for-Service	1942732920	1942732920	1	1	JABERZADEH ANSARI, MAJID MD	8/3/2020	207R00000X	NA	Other	026	PHYSICIANS	167213	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
167692	Fee-for-Service	1598774432	1598774432	1	1	JHA, VINAYAK M MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2351 CLAY STREET	SUITE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
167697	Fee-for-Service	1073839395	1073839395	1	1	JOHNSTON, LISA L OT	12/18/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
167813	Fee-for-Service	1770988370	1770988370	1	1	JWCH INSTITUTE INC	2/25/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	19	06037	33.93782301	-118.1288691	Los Angeles County
167824	Fee-for-Service	1407808058	1407808058	1	1	JWCH INSTITUTE INC	6/9/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	522 S SAN PEDRO	None	LOS ANGELES	CA	90013	2102	19	06037	34.0436196	-118.2442541	Los Angeles County
167825	Fee-for-Service	1689698052	1689698052	1	1	JASSAL, SIMERJOT K MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70679	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
167942	Fee-for-Service	1558542209	1558542209	1	1	JONAS, BRIAN A MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105278	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
167946	Fee-for-Service	1265696280	1265696280	1	1	JOEY PAPA MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1351 WASHINGTON BLVD	FL 6	STAMFORD	CT	06902	2419	00	None	41.05814358	-73.54336039	Western Connecticut Planning Region
167978	Fee-for-Service	1598774432	1598774432	1	1	JHA, VINAYAK M MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131832	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2351 CLAY STREET	SUITE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
168027	Fee-for-Service	1427312289	1427312289	1	1	JEE, OLIVIA D J MD	9/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130448	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168071	Fee-for-Service	1053722124	1053722124	1	1	JOHN H CLANCY DO AND TARA	8/22/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LEIGH CLANCY DO MEDICAL	2375 S MELROSE DR	None	VISTA	CA	92081	8788	37	06073	33.14409946	-117.2417711	San Diego County
168093	Fee-for-Service	1780697342	1780697342	1	1	JOHNSON, JULIE A MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	08	Family Practice	0	In state provider	None	505 S BUENA VISTA	None	CORONA	CA	92882	1901	33	06065	33.87798339	-117.5774303	Riverside County
168102	Fee-for-Service	1770988370	1770988370	1	1	JWCH INSTITUTE INC	5/12/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	19	06037	33.93782301	-118.1288691	Los Angeles County
168115	Fee-for-Service	1689838989	1689838989	1	1	JAVAHERIAN, MOHAMMAD LAC	11/27/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168118	Fee-for-Service	1407808058	1407808058	1	1	JWCH INSTITUTE INC	9/6/2005	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	522 S SAN PEDRO	None	LOS ANGELES	CA	90013	2102	19	06037	34.0436196	-118.2442541	Los Angeles County
168199	Fee-for-Service	1598704058	1598704058	1	1	JACKIMCZYK, KENNETH 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	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
168228	Fee-for-Service	1558542209	1558542209	1	1	JONAS, BRIAN A MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105278	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
168245	Fee-for-Service	1952446650	1952446650	1	1	JIMENEZ, MONICA C PT	11/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2115 MONTIEL RD	STE 103	SAN MARCOS	CA	92069	3587	37	06073	33.1322413	-117.1176172	San Diego County
168265	Fee-for-Service	1497341747	1497341747	1	1	JOSEPH, JUBIN P MD	9/15/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	180893	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
168277	Fee-for-Service	1598758179	1598758179	1	1	JEWISH FAMILY SERVICE OF THE	2/28/2013	251V00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	DESERT	801 E TAHQUITZ CANYON WY	SUITE 202	PALM SPRINGS	CA	92262	6763	33	06065	33.82303847	-116.539146	Riverside County
168382	Fee-for-Service	1588666077	1588666077	1	1	JOSEPH D BASSO DPM INC	2/28/1992	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	340 TARAVAL ST	None	SAN FRANCISCO	CA	94116	1953	38	06075	37.74333621	-122.4698537	San Francisco County
168391	Fee-for-Service	1134300114	1134300114	1	1	JENNIFER M. HEALY, DO	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
168401	Fee-for-Service	1679685838	1679685838	1	1	JAFRI, RAZA MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94994	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
168402	Fee-for-Service	1407808058	1407808058	1	1	JWCH INSTITUTE INC	9/6/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	522 S SAN PEDRO	None	LOS ANGELES	CA	90013	2102	19	06037	34.0436196	-118.2442541	Los Angeles County
168603	Fee-for-Service	1316988017	1316988017	1	1	JUDSON, JEFFREY E	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	26230	01	General Practice	0	In state provider	None	513 E LIME AVE	None	MONROVIA	CA	91016	2982	19	06037	34.14819851	-117.993105	Los Angeles County
168624	Fee-for-Service	1194488866	1194488866	1	1	JESSICA PEREZ LICENSED PROFE	10/19/2021	261QM0801X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4740 GREEN RIVER RD	STE206A	CORONA	CA	92307	7814	33	06065	33.87742363	-117.6611817	Riverside County
168737	Fee-for-Service	1508209974	1508209974	1	1	JAHANGIRI, VIDA MD	5/1/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	139924	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
168871	Fee-for-Service	1467957563	1467957563	1	1	JADALI, PATRICK M	10/21/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2617 E CHAPMAN AVE	SUITE 303	ORANGE	CA	92869	3256	30	06059	33.7878445	-117.8254845	Orange County
168930	Fee-for-Service	1982192159	1982192159	1	1	JONES, RABUN	9/27/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
168984	Fee-for-Service	1861544660	1861544660	1	1	JIANG, XIAOHUA MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66292	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
168990	Fee-for-Service	1922091982	1922091982	1	1	JAMES CRAIG CAIN, 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
169060	Fee-for-Service	1962790451	1962790451	1	1	JOHNSON, MARION J LCSW	5/10/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
169116	Fee-for-Service	1700952728	1700952728	1	1	JUSTIS, RACHAEL G	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
169161	Fee-for-Service	1528402427	1528402427	1	1	JOHN, SANDHYA M MD	1/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	148769	22	Pathology (M.D. only)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
169331	Fee-for-Service	1437470465	1437470465	2	1	JONES, ANDREW L	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127002	None	None	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
169339	Fee-for-Service	1922250638	1922250638	1	1	JOAN MARIE CALANDRA PHD CLIN	9/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	NICAL PSYCHOLOGIST INC	11340 W OLYMPIC BLVD	STE 150	LOS ANGELES	CA	90064	1608	19	06037	34.03770466	-118.4419168	Los Angeles County
169398	Fee-for-Service	1619455433	1619455433	1	1	JOSE, JEREMY RCP	1/8/2019	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
169466	Fee-for-Service	1285940965	1285940965	1	1	JERI K SPENCER, NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
169478	Fee-for-Service	1134183114	1134183114	1	1	JIBRIL, DEANAH A DO	5/13/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17489	09	Gynecology (D.O. only)	0	In state provider	None	ONE HOAG DR	6100	NEWPORT BEACH	CA	92658	6100	30	06059	33.62421676	-117.9309656	Orange County
169486	Fee-for-Service	1912642026	1912642026	1	1	JOSEPH C. LU, DO. INC	5/17/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	438 LAS TUNAS	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
169648	Fee-for-Service	1083795330	1083795330	1	1	JULIAN DAVIES 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
169733	Fee-for-Service	1821594946	1821594946	1	1	JOSE, JISHA MD	12/11/2024	2080N0001X	NA	Pediatric Primary Care	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
169813	Fee-for-Service	1255379764	1255379764	1	1	JORETEG, CHRISTER A MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54456	41	Internal Medicine	0	In state provider	None	1600 S IMPERIAL AVE	STE 4	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
169842	Fee-for-Service	1598829350	1598829350	1	11	JWCH INSTITUTE, INC	8/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12124 BULLIS ROAD	STE B104	LYNWOOD	CA	90262	5106	19	06037	33.91614168	-118.2044211	Los Angeles County
169880	Fee-for-Service	1164934253	1164934253	1	1	JASCULCA, CAROLYN M LMFT	1/16/2025	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
169887	Fee-for-Service	1992819296	1992819296	1	1	JENNIFER PLUMB,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
169902	Fee-for-Service	1033220033	1033220033	1	1	JONES, KIMBERLY C MD	1/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54859	40	Pediatrics	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
169907	Fee-for-Service	1154344919	1154344919	1	1	JAIN, ASHIT MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50605	41	Internal Medicine	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
169977	Fee-for-Service	1821542960	1821542960	1	1	JABONILLO, KEITH C NP	6/11/2018	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
170020	Fee-for-Service	1790772911	1790772911	1	1	JOHN BARRETT	12/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
170131	Fee-for-Service	1598829350	1598829350	1	11	JWCH INSTITUTE, INC	8/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12124 BULLIS ROAD	STE B104	LYNWOOD	CA	90262	5106	19	06037	33.91614168	-118.2044211	Los Angeles County
170133	Fee-for-Service	1780761577	1780761577	1	1	JONES, HEIDI A DC	2/20/2023	111N00000X	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
170210	Fee-for-Service	1407808058	1407808058	1	10	JWCH INSTITUTE INC	12/12/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	628 SAN JULIAN ST	None	LOS ANGELES	CA	90014	2412	19	06037	34.04203464	-118.2467644	Los Angeles County
170237	Fee-for-Service	1750478665	1750478665	1	1	J J'S PHARMACY, LLC	10/28/2005	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21010 GOLDEN SPRINGS DR	None	DIAMOND BAR	CA	91765	3831	19	06037	33.99931857	-117.8456303	Los Angeles County
170261	Fee-for-Service	1659680395	1659680395	1	2	JONES, JASMINE R LCSW	3/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	851 PINE AVENUE	#102	LONG BEACH	CA	90813	0400	19	06037	33.777585	-118.1923955	Los Angeles County
170272	Fee-for-Service	1609972066	1609972066	1	1	JUGO, MICHAEL J MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90173	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
170285	Fee-for-Service	1821101536	1821101536	1	1	JOHNSON, LINDA 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	665 WINTER ST	None	SALEM	OR	97301	0000	00	None	44.933211	-123.0355125	Marion County
170315	Fee-for-Service	1477560431	1477560431	1	1	JOHL, JENNIFER MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS NE	None	ALBUQUERQUE	NM	87131	0001	00	None	35.08771808	-106.6192188	Bernalillo County
170318	Fee-for-Service	1184343733	1184343733	1	1	JOHNSON, PAIGE M PHD	9/28/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
170382	Fee-for-Service	1225456742	1225456742	1	1	JAG REDDY MD INC	12/10/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	82683	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6410	30	06059	33.56008604	-117.6657795	Orange County
170408	Fee-for-Service	1356394811	1356394811	1	1	JACOBSEN, JAMES C MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87878	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
170433	Fee-for-Service	1558455162	1558455162	1	1	JEX, CRAIG T DPM	10/16/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4000 STOCKDALE	STE C	BAKERSFIELD	CA	93309	2059	15	06029	35.35429352	-119.0531115	Kern County
170480	Fee-for-Service	1164594867	1164594867	1	1	JACKSON CHIROPRACTIC INC	1/14/2008	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3330 CAMERON PARK DRIVE	SUITE 200	CAMERON PARK	CA	95682	7652	09	06017	38.67964826	-120.9819725	El Dorado County
170498	Fee-for-Service	1407808058	1407808058	1	10	JWCH INSTITUTE INC	12/12/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	628 SAN JULIAN ST	None	LOS ANGELES	CA	90014	2412	19	06037	34.04203464	-118.2467644	Los Angeles County
170529	Fee-for-Service	1982829248	1982829248	1	1	JUAREZ, THADDEUS M MD	12/7/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	83085	-	NOT APPLICABLE	0	In state provider	None	2500 WILSHIRE BLVD	SUITE 704	LOS ANGELES	CA	90057	4312	19	06037	34.06026667	-118.2809971	Los Angeles County
170631	Fee-for-Service	1598829350	1598829350	1	5	JWCH INSTITUTE, INC	6/24/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	964 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.089372	-118.291723	Los Angeles County
170660	Fee-for-Service	1013412162	1013412162	1	1	JOHNSON, ELIZABETH J MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	164347	None	None	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
170665	Fee-for-Service	1225456742	1225456742	1	1	JAG REDDY MD INC	12/10/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	82683	77	Infectious Disease	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6410	30	06059	33.56008604	-117.6657795	Orange County
170701	Fee-for-Service	1306130257	1306130257	1	1	JOHNSON, JENNIFER	12/4/2024	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
170742	Fee-for-Service	1346476884	1346476884	1	1	JONG, BEVERLY E MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136770	05	Anesthesiology	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
170749	Fee-for-Service	1184077505	1184077505	1	1	JONES, KATHRYCE J NP	1/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
170752	Fee-for-Service	1407858418	1407858418	1	1	JENSEN, LLYOD R MD	8/2/2017	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
170802	Fee-for-Service	1720616923	1720616923	1	1	JENKINS, COLIN MD	2/17/2025	207LC0200X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
170906	Fee-for-Service	1053807602	1053807602	1	1	JOHNSON, SHERONDA L NP	4/11/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
170919	Fee-for-Service	1598829350	1598829350	1	5	JWCH INSTITUTE, INC	6/24/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	964 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.089372	-118.291723	Los Angeles County
170930	Fee-for-Service	1093065336	1093065336	1	1	JACOBSON, BRIAN E PT	12/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
170941	Fee-for-Service	1174572028	1174572028	1	1	JJ&R EMERGENCY MED GROUP	6/6/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CA HOSP MED CTR	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
170976	Fee-for-Service	1669945234	1669945234	1	1	JIANG, SHUAI PT	5/2/2019	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
170977	Fee-for-Service	1689056608	1689056608	1	1	JANEWAY, HANNAH H MD	2/22/2019	207P00000X	NA	Other	026	PHYSICIANS	144545	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
171089	Fee-for-Service	1508803636	1508803636	1	1	JENSEN, KRISTI A OD	2/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	SUITE 2	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
171180	Fee-for-Service	1528087921	1528087921	1	1	JOHNSTON, LIZ B LCSW	8/1/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1129 MARSH ST	None	SAN LUIS OBISPO	CA	93401	3323	40	06079	35.28151781	-120.6582022	San Luis Obispo County
171194	Fee-for-Service	1609865559	1609865559	1	1	JOSEPH E.WAGNER M.D	7/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
171252	Fee-for-Service	1639212558	1639212558	1	1	JORDAN, RICHARD MD	5/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	94116	41	Internal Medicine	0	In state provider	None	4476 TWEEDY BLVD	None	SOUTHGATE	CA	90280	6359	19	06037	33.94280053	-118.1931037	Los Angeles County
171296	Fee-for-Service	1457424004	1457424004	1	1	JULIAN, CAESAR O MD	10/15/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	29218	01	General Practice	0	In state provider	None	41505 CARLOTTA DRIVE	None	PALM DESERT	CA	92211	3279	33	06065	33.745986	-116.344298	Riverside County
171340	Fee-for-Service	1598829350	1598829350	1	2	JWCH INSTITUTE, INC	12/18/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1670 E 120TH ST	BLDG W SUPPORT 14 FL 1	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
171342	Fee-for-Service	1740370238	1740370238	1	1	JONES, RONALD B MD	2/3/1988	174400000X	NA	Other	026	PHYSICIANS	39637	20	Orthopedic Surgery	0	In state provider	None	3304 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239308	-124.1360417	Humboldt County
171345	Fee-for-Service	1699872630	1699872630	1	1	JACOBS, RANDY	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61654	07	Dermatology	0	In state provider	DERMATOLOGY INC	27640 ENCANTO DR	None	SUN CITY	CA	92586	4542	33	06065	33.71935134	-117.1886049	Riverside County
171364	Fee-for-Service	1639664824	1639664824	1	1	JUE, JEFFREY PT	2/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
171380	Fee-for-Service	1003877200	1003877200	1	1	JACQUELINE T CAIRE 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
171577	Fee-for-Service	1295052371	1295052371	1	1	JONES, PATRICIA M LPCC	9/30/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
171585	Fee-for-Service	1457424004	1457424004	1	1	JULIAN, CAESAR O MD	10/15/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	29218	08	Family Practice	0	In state provider	None	41505 CARLOTTA DRIVE	None	PALM DESERT	CA	92211	3279	33	06065	33.745986	-116.344298	Riverside County
171611	Fee-for-Service	1235213075	1235213075	1	1	JOSEPH A. CORSER M.D.	10/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
171627	Fee-for-Service	1598829350	1598829350	1	2	JWCH INSTITUTE, INC	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1670 E 120TH ST	BLDG W SUPPORT 14 FL 1	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
171684	Fee-for-Service	1497956361	1497956361	1	1	JAMES BRYSON MCCAIN M.D.	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 KANAWHA BLVD E	None	CHARLESTON	WV	25301	2400	00	None	38.34470937	-81.63296112	Kanawha County
171705	Fee-for-Service	1396765673	1396765673	1	1	JAVAHERIAN, AFSHIN S DPM	10/16/2007	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8737 BEVERLY BLVD	SUITE 103	WEST HOLLYWOOD	CA	90048	1835	19	06037	34.07687959	-118.381876	Los Angeles County
171751	Fee-for-Service	1407625205	1407625205	1	1	JONES, SHANEE A	6/4/2024	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	38	06075	0	0	None
171904	Fee-for-Service	1588297683	1588297683	1	2	JMI TRANSPORTATION, LLC	5/25/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	915 HIGHLAND POINTE DR	250	ROSEVILLE	CA	95678	5421	31	06061	38.78338654	-121.2837779	Placer County
171911	Fee-for-Service	1528615622	1528615622	1	1	JDTJE CORPORATION	6/1/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3135 CLAYTON ROAD	SUITE 103	CONCORD	CA	94519	2796	07	06013	37.97326554	-122.0205438	Contra Costa County
171916	Fee-for-Service	1821521964	1821521964	1	1	JUNG, HEE SUN	11/27/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	160 W COCHRAN ST	None	SIMI VALLEY	CA	93065	6215	56	06111	34.28430649	-118.8022388	Ventura County
172002	Fee-for-Service	1568484152	1568484152	1	1	JACK ROY ERWIN, 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	4740 NE STALLINGS DR	None	NACOGDOCHES	TX	75965	1615	00	None	31.65212049	-94.651479	Nacogdoches County
172009	Fee-for-Service	1407440407	1407440407	1	1	JOHNSTON, RACHEL M	8/14/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172080	Fee-for-Service	1336236959	1336236959	1	1	JOHNSON, BYRON W MD	11/19/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
172117	Fee-for-Service	1780208793	1780208793	1	1	JANG, DANIEL MD	8/2/2023	207R00000X	NA	Other	026	PHYSICIANS	187092	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
172173	Fee-for-Service	1699814665	1699814665	1	1	JARED R. SADLER	10/21/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2925 RYAN DR SE	None	SALEM	OR	97301	9687	00	None	44.920224	-123.001551	Marion County
172199	Fee-for-Service	1528615622	1528615622	1	1	JDTJE CORPORATION	6/1/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3135 CLAYTON ROAD	SUITE 103	CONCORD	CA	94519	2796	07	06013	37.97326554	-122.0205438	Contra Costa County
172243	Fee-for-Service	1366702946	1366702946	1	1	JIANG, EMILY K MD	12/31/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158924	08	Family Practice	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
172261	Fee-for-Service	1871145110	1871145110	1	1	JANAKIRAM, NIKHILA K MD	8/14/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	190466	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
172313	Fee-for-Service	1427586387	1427586387	1	1	JONES, JUSTIN L MD	6/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149001	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
172372	Fee-for-Service	1558379503	1558379503	1	1	JODHKA, JOGINDER S MD	10/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	48191	41	Internal Medicine	0	In state provider	SO CA PERMANENTE MED GRP	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
172383	Fee-for-Service	1164914321	1164914321	1	1	JESSUP, CARSEN CCC-SLP	11/15/2021	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
172418	Fee-for-Service	1023635513	1023635513	1	1	JURADO, CHRYSTAL JOY D	10/7/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3269 D ST	None	HAYWARD	CA	94541	4585	01	06001	37.678888	-122.0482923	Alameda County
172497	Fee-for-Service	1598829350	1598829350	1	8	JWCH INSTITUTE, INC	3/16/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	855 N VERMONT AVE	STUDENT SERVICES 120	LOS ANGELES	CA	90029	3529	19	06037	34.086699	-118.2917585	Los Angeles County
172499	Fee-for-Service	1609161132	1609161132	1	1	JESSEL, ARIELLA	7/22/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
172541	Fee-for-Service	1255721593	1255721593	1	1	JUAN, ILONA C MD	8/6/2021	207L00000X	NA	Other	026	PHYSICIANS	158444	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
172595	Fee-for-Service	1164473005	1164473005	1	1	JERNIGAN,PERRY MD	8/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 SUNSET DRIVE	STE 3	JOHNSON CITY	TN	37604	0000	00	None	36.329022	-82.3912785	Washington County
172596	Fee-for-Service	1629482781	1629482781	1	1	JIANG, CAN MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138424	08	Family Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172638	Fee-for-Service	1760554505	1760554505	1	1	JONES, C. DARRYL	6/14/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76808	30	Radiology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
172647	Fee-for-Service	1083665293	1083665293	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC.	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
172659	Fee-for-Service	1558379503	1558379503	1	1	JODHKA, JOGINDER S MD	10/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	48191	45	Nephrology (Renal-Kidney)	0	In state provider	SO CA PERMANENTE MED GRP	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
172718	Fee-for-Service	1740691195	1740691195	1	1	JABOURIAN, ALEX DO	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	14278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	36	06071	34.073505	-117.3505995	San Bernardino County
172788	Fee-for-Service	1598829350	1598829350	1	8	JWCH INSTITUTE, INC	3/16/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	855 N VERMONT AVE	STUDENT SERVICES 120	LOS ANGELES	CA	90029	3529	19	06037	34.086699	-118.2917585	Los Angeles County
172884	Fee-for-Service	1093981276	1093981276	1	1	JOHNSTON, MOLLIE M MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107991	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA DR	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
172887	Fee-for-Service	1194976910	1194976910	1	1	JENNIFER GIBBS, NP	7/18/2015	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	2719	00	None	35.08771808	-106.6192188	Bernalillo County
172940	Fee-for-Service	1407852858	1407852858	1	1	JOHL,JEWEL MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69437	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
172962	Fee-for-Service	1790738516	1790738516	1	1	JEFFERY J.GILBERTSON 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	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
172977	Fee-for-Service	1649404740	1649404740	1	1	JONES, BRANDON Q MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114950	01	General Practice	0	In state provider	None	321 MIDDLEFIELD RD	FLOOR 1	MENLO PARK	CA	94025	4429	41	06081	37.45657153	-122.168099	San Mateo County
173001	Fee-for-Service	1992842611	1992842611	1	1	JYOTI PARMANAND BALANI 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
173101	Fee-for-Service	1639129042	1639129042	1	1	JAMES DEANGELIS, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 MEMORIAL DRIVE	None	FARRELL	PA	16121	1357	00	None	41.20946207	-80.46971646	Mercer County
173171	Fee-for-Service	1427645027	1427645027	1	1	JOY AND HARMONY, A FAMILY CO	6/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	UNSELING SERVICE CORP	3400 CENTRAL AVE	310	RIVERSIDE	CA	92506	2181	33	06065	33.95355249	-117.385407	Riverside County
173217	Fee-for-Service	1841489358	1841489358	1	1	JENSEN, BRIAN K LMFT	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	145 S WASHINGTON ST	STE 1	SONORA	CA	95370	4722	55	06109	37.98347745	-120.3821927	Tuolumne County
173260	Fee-for-Service	1275829087	1275829087	1	1	JORDAN, LAUREN E MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135237	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
173279	Fee-for-Service	1255355228	1255355228	1	1	JASON DEWEES	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
173287	Fee-for-Service	1245400274	1245400274	1	1	JENKINS, JENNIFER H CRNA	3/21/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
173532	Fee-for-Service	1609194570	1609194570	1	1	JAHANPANAH, FERESHTEH MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65104	41	Internal Medicine	0	In state provider	APMC	1333 E MAIN STREET	None	EL CAJON	CA	92021	6540	37	06073	32.79689141	-116.9338985	San Diego County
173549	Fee-for-Service	1750062121	1750062121	1	1	JEW, MARCUS CRNA	2/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
173580	Fee-for-Service	1831721778	1831721778	1	1	JAMIE WONG OD INC	10/12/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1895 MOWRY AVE	117	FREMONT	CA	94538	1736	01	06001	37.55909066	-121.9799265	Alameda County
173583	Fee-for-Service	1457394538	1457394538	1	1	JONES, RHYS MD	3/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176161	None	None	0	In state provider	None	16630 BROADWAY	None	GARDENA	CA	90248	2716	19	06037	33.87988966	-118.278108	Los Angeles County
173585	Fee-for-Service	1043572217	1043572217	1	1	JBP PHYSICAL THERAPY CORPORA	7/6/2019	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9545 RESEDA BLVD	STE. 3 & 4	NORTHRIDGE	CA	91324	2312	19	06037	34.24381621	-118.5361155	Los Angeles County
173617	Fee-for-Service	1760860357	1760860357	1	1	JOHNSON, CALI E MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135994	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
173663	Fee-for-Service	1215592076	1215592076	1	1	JUNG, SEAN H MD MPH	5/30/2023	208M00000X	NA	Other	026	PHYSICIANS	176727	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
173709	Fee-for-Service	1609951029	1609951029	2	1	JOE, LORAH L LCSW	1/22/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20242	-	NOT APPLICABLE	0	In state provider	None	2504 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2520	19	06037	33.9598587	-118.3211468	Los Angeles County
173848	Fee-for-Service	1679849558	1679849558	1	1	JONNA, LAKSHMI M MD	11/1/2020	207LP3000X	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
174003	Fee-for-Service	1528646593	1528646593	1	1	JAIN, SAMKIT MD	10/7/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
174101	Fee-for-Service	1538553904	1538553904	1	1	JADDAOUI, JESSICA S MD	7/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163011	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
174134	Fee-for-Service	1295039956	1295039956	1	1	JCL PHARMACY INC	11/7/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7548 SOQUEL DR	None	APTOS	CA	95003	3820	44	06087	36.98187274	-121.9102532	Santa Cruz County
174327	Fee-for-Service	1639281751	1639281751	1	1	JOSHI, SONALI S MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112373	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
174453	Fee-for-Service	1215243712	1215243712	1	1	JOCHAI, DIANA PHD	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24926	-	NOT APPLICABLE	0	In state provider	None	1403 W LOMITA BLVD	STE 102, RM 1-26	HARBOR CITY	CA	90710	2084	19	06037	33.79785936	-118.3016552	Los Angeles County
174467	Fee-for-Service	1558380683	1558380683	1	1	JAMES, ROBERT E MD	4/15/2008	208800000X	NA	Other	026	PHYSICIANS	62449	34	Urology and Urological Surgery	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
174484	Fee-for-Service	1659884278	1659884278	1	1	J & D HEALTHCARE INC	5/7/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9635 MONTE VISTA AVE SUI	None	MONTCLAIR	CA	91763	2235	36	06071	34.07975926	-117.6982207	San Bernardino County
174506	Fee-for-Service	1831200633	1831200633	1	1	JANKOWSKI, EVELYN MD INC	5/9/2014	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10316 WOODLEY AVE	None	GRANADA HILLS	CA	91344	6916	19	06037	34.258077	-118.484801	Los Angeles County
174683	Fee-for-Service	1598708547	1598708547	1	1	JOU, MIKE C DPM	2/3/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
174795	Fee-for-Service	1518324284	1518324284	2	1	JALEH NIAZI, M.D., INC.	7/17/2019	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	900 COLUSA AVE	204	BERKELEY	CA	94707	2321	01	06001	37.89113354	-122.2792919	Alameda County
174849	Fee-for-Service	1174027692	1174027692	1	1	JONES, ANDREW J MD	6/17/2021	390200000X	NA	Other	026	PHYSICIANS	163735	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
174857	Fee-for-Service	1770927857	1770927857	1	1	JASMINE A HUDNALL	5/4/2022	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
174903	Fee-for-Service	1851481535	1851481535	1	1	JANI, ALKESH M MD	1/1/2018	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
174916	Fee-for-Service	1427041185	1427041185	1	1	JUNG, DIANNE KWOCK	3/12/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FOX DRUG STORE	1939 HIGH ST	None	SELMA	CA	93662	3578	10	06019	36.56817108	-119.6114077	Fresno County
174972	Fee-for-Service	1326025057	1326025057	1	1	JOHNSON, GREGORY L MD	5/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	72200	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175053	Fee-for-Service	1821186347	1821186347	1	1	JONES-CHAMBERS, MAKESHA PSY	6/29/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
175058	Fee-for-Service	1366157919	1366157919	1	1	JANG, JUNG Y PHD	8/29/2023	103T00000X	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
175127	Fee-for-Service	1831426691	1831426691	1	1	JEEVANJEE, SARA MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114753	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
175171	Fee-for-Service	1235243783	1235243783	1	1	JUAN T COCJIN, MD	11/15/2012	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
175190	Fee-for-Service	1851481535	1851481535	1	1	JANI, ALKESH M MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
175319	Fee-for-Service	1447458088	1447458088	1	1	JOSEPH, SPASKA D LMFT	12/15/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47761	-	NOT APPLICABLE	0	In state provider	None	1920 MARENGO STREET	None	LOS ANGELES	CA	90033	1317	19	06037	34.05751768	-118.2095235	Los Angeles County
175355	Fee-for-Service	1386974491	1386974491	1	1	JACKSON MEDICAL SUPPLY INC	7/2/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	506 MAIN ST	None	VACAVILLE	CA	95688	3922	48	06095	38.35662685	-121.9873396	Solano County
175357	Fee-for-Service	1871671958	1871671958	1	1	JACKSON, ROSS T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36824	07	Dermatology	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
175497	Fee-for-Service	1740843390	1740843390	1	1	JAMEEL, AZHER MD	11/8/2022	390200000X	NA	Other	026	PHYSICIANS	176300	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
175561	Fee-for-Service	1154783751	1154783751	1	1	JAVADIAN, POUYA MD	10/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160175	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
175621	Fee-for-Service	1649293119	1649293119	1	1	JAFFE, WYATT C MD	11/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79244	66	Emergency Medicine (Urgent Care)	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
175642	Fee-for-Service	1710046347	1710046347	1	1	JAFFE, LINDA J MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84447	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
175652	Fee-for-Service	1932663382	1932663382	1	1	JOHNSON, DAWN R CRNA	3/16/2020	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
175792	Fee-for-Service	1790749877	1790749877	1	1	JUAREZ-REYES, MARIA G MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72395	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
175812	Fee-for-Service	1659573475	1659573475	1	1	JOSEPH ROSSI BERGER, 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
175866	Fee-for-Service	1184835407	1184835407	1	1	JENSON, PETER M MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92857	08	Family Practice	0	In state provider	None	28780 SINGLE OAK DR	SUITE 160	TEMECULA	CA	92590	4080	33	06065	33.49890392	-117.1612965	Riverside County
175942	Fee-for-Service	1750517231	1750517231	1	1	JAMOONA, AMRITH MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134229	14	Neurological Surgery	0	In state provider	None	1401 SPANOS COURT	SUITE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
176108	Fee-for-Service	1649374299	1649374299	1	1	JANG, GEUN C MD	9/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25828	30	Radiology	0	In state provider	None	11234 ANDERSON ST	BLDG 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
176127	Fee-for-Service	1548451727	1548451727	1	1	JESSE, MARY K MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
176150	Fee-for-Service	1952386088	1952386088	1	1	JAIN, SANJAY MD	12/17/2021	207L00000X	NA	Other	026	PHYSICIANS	75511	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
176271	Fee-for-Service	1972966182	1972966182	1	1	JAFARI, LUA A MD	4/19/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	168737	None	None	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
176333	Fee-for-Service	1285029595	1285029595	1	1	JEANTY HIGGINS, NAOMI MD	8/8/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170809	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
176424	Fee-for-Service	1386878122	1386878122	1	1	JAITUNI, REENA S MD	8/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107400	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
176456	Fee-for-Service	1336213644	1336213644	1	1	JOHNSON, RONALD MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44679	18	Ophthalmology	0	In state provider	None	95 RED ROCK WAY	APT M111	SAN FRANCISCO	CA	94131	3507	38	06075	37.74649449	-122.4415655	San Francisco County
176481	Fee-for-Service	1538162201	1538162201	1	1	JOHNSON, MARTIN L MD	7/28/2023	208200000X	NA	General Surgery	026	PHYSICIANS	37362	None	None	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
176493	Fee-for-Service	1053475095	1053475095	1	1	JOHNSON, KRISTINA G PSYD	10/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
176507	Fee-for-Service	1568009512	1568009512	1	1	JANETS ENTERPRISE INC	5/21/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6782 CITRUS AVE	None	FONTANA	CA	92336	1403	36	06071	34.130808	-117.4536555	San Bernardino County
176525	Fee-for-Service	1568611812	1568611812	1	1	JERNAZIAN, HAYK 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
176576	Fee-for-Service	1578753117	1578753117	1	1	JACOBS, DAVID M PHD	9/12/2014	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
176589	Fee-for-Service	1326608761	1326608761	1	1	JARGALSAIKHAN, KHALIUN LMFT	8/5/2023	106H00000X	NA	Mental Health Outpatient Services	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
176601	Fee-for-Service	1477671196	1477671196	1	1	JOHNSTON, TEDDY R LMFT	4/26/2020	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
176608	Fee-for-Service	1215515648	1215515648	1	1	JUNG, SOOMIN MD	5/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188343	08	Family Practice	0	In state provider	None	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
176675	Fee-for-Service	1043590649	1043590649	1	1	JIANG, FONDA MD	12/9/2024	207K00000X	NA	Other	026	PHYSICIANS	142275	03	Allergy	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
176680	Fee-for-Service	1427058643	1427058643	1	1	JAVIER ROMAN GONZALEZ	8/31/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6700 W IH 10	None	SAN ANTONIO	TX	78201	2009	00	None	29.49018968	-98.54649731	Bexar County
176811	Fee-for-Service	1790014090	1790014090	1	1	JINDAL, HIRA L MD INC	1/1/1979	207RN0300X	NA	Nephrology	026	PHYSICIANS	26281	41	Internal Medicine	0	In state provider	None	711 W COLLEGE ST	STE 590	LOS ANGELES	CA	90012	1256	19	06037	34.06541412	-118.2414102	Los Angeles County
176814	Fee-for-Service	1699235135	1699235135	1	1	JAFFERY, ALEQ MD	2/17/2023	207P00000X	NA	Other	026	PHYSICIANS	182895	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
176904	Fee-for-Service	1134458797	1134458797	1	1	JENNIFER KEANY & ASSOCIATES	11/10/2014	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	8936 S SEPULVEDA BLVD	SUITE 200	LOS ANGELES	CA	90045	3628	19	06037	33.954957	-118.3961925	Los Angeles County
176912	Fee-for-Service	1235575721	1235575721	1	1	JEFFREY MCDANNEL	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3810 PLAZA WAY	None	KENNEWICK	WA	99338	2722	00	None	46.17644625	-119.1911845	Benton County
177028	Fee-for-Service	1912950932	1912950932	1	1	JOHNRE CARE LLC	4/30/2006	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	461 E JOHNSTON AVE	None	HEMET	CA	92543	7113	33	06065	33.7330055	-116.9677845	Riverside County
177051	Fee-for-Service	1174554521	1174554521	1	1	JACKOSN, LANCE 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	18518 HARDY OAK	SUITE 300	SAN ANTONIO	TX	78258	4271	00	None	29.6124993	-98.47841802	Bexar County
177166	Fee-for-Service	1447662390	1447662390	1	1	JONES, LARA C MD	10/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	136820	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
177212	Fee-for-Service	1881154755	1881154755	1	1	JACOBSEN, BAILEE DO	5/15/2023	2084A0401X	NA	Psychiatry	026	PHYSICIANS	20056	None	None	0	In state provider	None	20103 LAKE CHABOT	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
177231	Fee-for-Service	1053808170	1053808170	1	1	JEAN, JOSEPH J MD	4/13/2022	207P00000X	NA	Other	026	PHYSICIANS	176830	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
177409	Fee-for-Service	1720092703	1720092703	1	1	JONES JODI DANIELLE D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
177413	Fee-for-Service	1417037946	1417037946	1	1	JBJC INCORPORATED	12/26/2018	261QP2000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2357 W MARCH LN	None	STOCKTON	CA	95207	5239	39	06077	37.985458	-121.336447	San Joaquin County
177417	Fee-for-Service	1427011196	1427011196	1	1	JEANNE MARIE DILLENBECK, 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
177525	Fee-for-Service	1205984259	1205984259	1	1	JUBOORI, MICHAEL A MD	4/30/1993	2084P0804X	NA	Psychiatry	026	PHYSICIANS	41074	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
177536	Fee-for-Service	1508829748	1508829748	1	1	JACOBSON,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	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	0000	00	None	45.20010494	-123.1656951	Yamhill County
177599	Fee-for-Service	1750614442	1750614442	1	1	JOHNSON, AUDREY S LMFT	9/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23632 CALABASAS ROAD	SUITE #103	CALABASAS	CA	91302	3774	19	06037	34.15613926	-118.6421933	Los Angeles County
177617	Fee-for-Service	1851468748	1851468748	1	1	JUDGE, ANISHA J MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76004	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
177642	Fee-for-Service	1578539797	1578539797	1	1	JACQUET, JAMES M MD	11/27/1985	208600000X	NA	General Surgery	026	PHYSICIANS	33032	02	General Surgery	0	In state provider	None	15525 POMERADO RD	STE C8	POWAY	CA	92064	2426	37	06073	32.99479918	-117.0579468	San Diego County
177701	Fee-for-Service	1417037946	1417037946	1	1	JBJC INCORPORATED	3/5/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2357 W MARCH LN	None	STOCKTON	CA	95207	5239	39	06077	37.985458	-121.336447	San Joaquin County
177825	Fee-for-Service	1720564958	1720564958	1	2	JEANNIE SITU, O.D., INC.	7/1/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12234 PALMDALE RD	None	VICTORVILLE	CA	92392	9418	19	06037	34.509285	-117.396792	San Bernardino County
177830	Fee-for-Service	1093758757	1093758757	1	1	JURKOWSKI, LEONARD A MD	6/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43217	01	General Practice	0	In state provider	None	10605 SCRIPPS POWAY PKWY	SUITE C	SAN DIEGO	CA	92131	3925	37	06073	32.93714729	-117.0990446	San Diego County
177853	Fee-for-Service	1710752357	1710752357	1	1	JOYA, MARIAM PT	2/19/2024	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
177930	Fee-for-Service	1235606823	1235606823	1	2	JOHN MUIR PHYSICIANS PC	10/31/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	348 RHEEM BLVD	None	MORAGA	CA	94556	1516	07	06013	37.86118691	-122.1278716	Contra Costa County
177937	Fee-for-Service	1205126471	1205126471	1	1	JONGRO MEDICAL SUPPLY, INC	11/16/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9442 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1453	30	06059	33.77387251	-117.9675315	Orange County
177994	Fee-for-Service	1336152099	1336152099	1	1	JAMEI, MOHSEN MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84432	41	Internal Medicine	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
177995	Fee-for-Service	1134229347	1134229347	1	2	JOHNSTONE, MARGARET A NP	9/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	14501	-	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
178087	Fee-for-Service	1245318849	1245318849	1	1	JONELIS, FRANK J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28239	07	Dermatology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
178115	Fee-for-Service	1558621722	1558621722	1	1	JORDAN, RACHEL C MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129672	40	Pediatrics	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
178154	Fee-for-Service	1730834417	1730834417	1	1	JOHNSON, KENNADY PT	1/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178185	Fee-for-Service	1740294388	1740294388	1	1	JAMISON, ERIC R MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57982	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
178189	Fee-for-Service	1376552828	1376552828	1	1	JONES, KIMBERLY A LMFT	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3067 FREEPORT BLVD	STE 9	SACRAMENTO	CA	95818	4347	34	06067	38.54850759	-121.4894843	Sacramento County
178259	Fee-for-Service	1932102100	1932102100	1	1	JENNIFER CRAIG	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 E 3RD ST	None	DELTA	CO	81416	2815	00	None	38.74319827	-108.0470522	Delta County
178386	Fee-for-Service	1730293275	1730293275	1	1	J I INVESTMENTS INC	11/1/2001	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	22114 S VERMONT AVE	STE 101	TORRANCE	CA	90502	2161	19	06037	33.82665036	-118.2901491	Los Angeles County
178472	Fee-for-Service	1740294388	1740294388	1	1	JAMISON, ERIC R MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57982	08	Family Practice	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
178487	Fee-for-Service	1275546012	1275546012	1	1	JAMES HUTCHISON	2/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1423 N JEFFERSON AVE	None	SPRINGFIELD	MO	65802	1917	00	None	37.22492991	-93.28917587	Greene County
178636	Fee-for-Service	1104293141	1104293141	1	1	JWCH INSTITUTE INC	4/21/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	303 E 52ND ST	None	LOS ANGELES	CA	90011	4513	19	06037	33.99526806	-118.2699516	Los Angeles County
178644	Fee-for-Service	1154547719	1154547719	1	1	JEYANANDARAJAN, DHIRAJ R MD	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91259	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
178662	Fee-for-Service	1386681997	1386681997	1	1	JAMES M RISCOE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN'S MEDICAL GROUP	2727 MCCLELLAND BLVD	None	JOPLIN	MO	64804	0000	00	None	37.06080628	-94.53202788	Jasper County
178685	Fee-for-Service	1790053544	1790053544	1	1	JOSSAN, PAULA V MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114329	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
178712	Fee-for-Service	1659305753	1659305753	1	1	JIANG, WEN MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99198	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
178769	Fee-for-Service	1487734596	1487734596	1	1	JARRAHI, BENJAMIN MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100771	40	Pediatrics	0	In state provider	None	1744 ALCATRAZ AVENUE	None	BERKELEY	CA	94703	2713	01	06001	37.84860565	-122.2722184	Alameda County
178772	Fee-for-Service	1598495954	1598495954	1	1	J&A MEDICAL TRANSPORT	7/8/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1402 W PICO AVE	SUITE 23	EL CENTRO	CA	92243	1377	13	06025	32.8056843	-115.5680983	Imperial County
178787	Fee-for-Service	1235104654	1235104654	1	1	JAMES J NEWMAN MD	1/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E PECAN ST	None	ALTUS	OK	73521	6141	00	None	34.63529809	-99.31892165	Jackson County
178822	Fee-for-Service	1477064517	1477064517	1	1	JONES, CHAUNDRA D	11/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1450 W 6TH ST.	105	CORONA	CA	92882	3039	33	06065	33.87829288	-117.5937519	Riverside County
178872	Fee-for-Service	1356678874	1356678874	1	1	JOHNSON, JENNA R LCSW	3/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2062 TALBERT DR.	500	CHICO	CA	95928	7707	04	06007	39.72096654	-121.801158	Butte County
178931	Fee-for-Service	1154547719	1154547719	1	1	JEYANANDARAJAN, DHIRAJ R MD	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91259	36	Psychiatry	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
178936	Fee-for-Service	1275966871	1275966871	1	1	JUNG, YURA LAC	10/6/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1720 W BALL RD	4A	ANAHEIM	CA	92804	5589	30	06059	33.8178465	-117.9425115	Orange County
178944	Fee-for-Service	1417418229	1417418229	1	1	JI, ELLEN	10/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20490	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
178952	Fee-for-Service	1023340510	1023340510	1	1	JOSHI, HETVI K MD	7/17/2023	208M00000X	NA	Other	026	PHYSICIANS	156218	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
178965	Fee-for-Service	1225794977	1225794977	1	1	JOEY P TRAN OD INC	5/18/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	618 BLOSSOM HILL RD	STE 100	SAN JOSE	CA	95123	3048	43	06085	37.25052736	-121.8422415	Santa Clara County
178973	Fee-for-Service	1790053544	1790053544	1	1	JOSSAN, PAULA V MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114329	67	Endocrinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
179241	Fee-for-Service	1407080419	1407080419	1	1	JAFFE, COURTNEY E NP	5/18/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
179325	Fee-for-Service	1093372054	1093372054	1	1	JUUNI MEDICAL TRANSPORT INC	10/20/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3468 CITRUS ST	F	LEMON GROVE	CA	91945	1503	37	06073	32.743359	-117.0407265	San Diego County
179338	Fee-for-Service	1538266481	1538266481	1	1	JOHNSON, WILLIAM H MD	9/30/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33577	30	Radiology	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
179346	Fee-for-Service	1275645236	1275645236	1	1	JULIANWANG, BETH E MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62155	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
179353	Fee-for-Service	1235590258	1235590258	1	1	JOHNSON, ALYSA H LCSW	8/11/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
179402	Fee-for-Service	1518011261	1518011261	1	1	JARAMILLO, LORENA MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87491	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179404	Fee-for-Service	1831458322	1831458322	1	1	JUNN, JACQUELINE C MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153590	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
179437	Fee-for-Service	1568218691	1568218691	1	1	JM PHARMACY CORP	6/13/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	437 N EUCLID AVE	STE B	ONTARIO	CA	91762	3456	36	06071	34.067988	-117.6521805	San Bernardino County
179483	Fee-for-Service	1487000790	1487000790	1	1	JACKSON, PASHA A MD	9/13/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159813	08	Family Practice	0	In state provider	None	2970 HILLTOP MALL RD.	304	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
179499	Fee-for-Service	1760551915	1760551915	1	1	JACOBSON, MARK D MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71151	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
179592	Fee-for-Service	1831547983	1831547983	1	1	JANINE HERR	4/18/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
179616	Fee-for-Service	1508966458	1508966458	1	1	JACOBSON, STEPHANIE N CNM	10/20/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
179667	Fee-for-Service	1831610484	1831610484	1	1	JENSEN, CHAD J MD	1/29/2023	207P00000X	NA	Other	026	PHYSICIANS	177763	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
179706	Fee-for-Service	1689178782	1689178782	1	1	JOHNSON, MEGAN C MD	4/14/2021	207P00000X	NA	Other	026	PHYSICIANS	164281	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
179728	Fee-for-Service	1699965731	1699965731	1	1	JOSAN, RAMNIK K MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97845	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
179750	Fee-for-Service	1518957992	1518957992	1	1	JAEGER, NANCY L MD	8/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88490	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
179787	Fee-for-Service	1760551915	1760551915	1	1	JACOBSON, MARK D MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71151	20	Orthopedic Surgery	0	In state provider	None	5555 RESERVOIR DR	STE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
179829	Fee-for-Service	1720137565	1720137565	1	1	JOHN MUIR TRAUMA PHYS	7/1/1987	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP - INTERNAL MED	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
179864	Fee-for-Service	1669713624	1669713624	1	1	JAYAKAR, SARANYA MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136237	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
179897	Fee-for-Service	1265936272	1265936272	1	1	JEU, CHRISTOPHER Y MD	1/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19113	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
179973	Fee-for-Service	1750698395	1750698395	1	1	JULIAN-ARAX, KAREN A LMFT	1/11/2019	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
179982	Fee-for-Service	1093746299	1093746299	1	1	JAVIER-BOCK, EMMA C MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53572	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
180056	Fee-for-Service	1104063999	1104063999	1	1	JOHNSTON, ROBIN K 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
180072	Fee-for-Service	1235103276	1235103276	1	1	JOHNSON, GORDON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	24800 SE STARK ST	None	GRESHAM	OR	97030	3378	00	None	45.516762	-122.4070245	Multnomah County
180101	Fee-for-Service	1982893566	1982893566	1	1	JESSEN, JENNIFER A NP	4/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
180139	Fee-for-Service	1609219740	1609219740	1	1	JESSE HAWKES M.D.	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 E SOUTH TEMPLE	None	SALT LAKE CTY	UT	84102	1507	00	None	40.76933651	-111.8610765	Salt Lake County
180157	Fee-for-Service	1235186628	1235186628	1	1	JUNAID QURESHI 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	1930 E THOMAS RD	None	PHOENIX	AZ	85016	7711	00	None	33.480774	-112.0396095	Maricopa County
180176	Fee-for-Service	1093730426	1093730426	1	1	JUNG, KENNETH D MD	8/22/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	84105	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
180228	Fee-for-Service	1295958718	1295958718	1	1	JOHN C FREMONT MED CLN	7/1/1994	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
180258	Fee-for-Service	1912396565	1912396565	1	1	JEON, YOUNG E MD	10/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154853	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
180266	Fee-for-Service	1225448756	1225448756	1	1	JIMENEZ, DANIEL J MD	8/16/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	141226	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
180297	Fee-for-Service	1043267099	1043267099	1	1	JACKOFSKY, GILBERT M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5750 DIVISION ST	STE 100	RIVERSIDE	CA	92506	3259	33	06065	33.947667	-117.380963	Riverside County
180350	Fee-for-Service	1447870696	1447870696	1	1	JONES, TASHZNA MD	4/21/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	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
180394	Fee-for-Service	1053513960	1053513960	1	1	JACOUBS-BEYE, JANIRA PHD	1/13/2014	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
180426	Fee-for-Service	1760022016	1760022016	1	1	JEM CARE HOSPICE	7/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	UNIT 206A-3	MONTCLAIR	CA	91763	2342	36	06071	34.08129954	-117.6966135	San Bernardino County
180590	Fee-for-Service	1093179756	1093179756	1	1	JOY, KATHRYN MD	9/27/2023	2086S0127X	NA	General Surgery	026	PHYSICIANS	187095	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
180618	Fee-for-Service	1659710051	1659710051	1	1	JOURABCHI, NATANEL MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124124	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
180689	Fee-for-Service	1841304128	1841304128	1	1	JADAV, RUPINDERJIT K NP	10/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH STREET	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
180715	Fee-for-Service	1760022016	1760022016	1	1	JEM CARE HOSPICE	7/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	UNIT 206A-3	MONTCLAIR	CA	91763	2342	36	06071	34.08129954	-117.6966135	San Bernardino County
180726	Fee-for-Service	1407884117	1407884117	1	1	JORGENSEN, JAMES P MD	2/1/1983	207L00000X	NA	Other	026	PHYSICIANS	21445	05	Anesthesiology	0	In state provider	DOCTORS HSP LAKEWOOD	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
180845	Fee-for-Service	1770900607	1770900607	1	1	JOCELYN PARROS	1/25/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	325 CUMBERLAND STREET	SUITE C	PITTSBURG	CA	94565	2205	07	06013	38.03292256	-121.882228	Contra Costa County
180848	Fee-for-Service	1578526299	1578526299	1	1	JOBALIA, THAICHAN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62153	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
180957	Fee-for-Service	1972651040	1972651040	1	1	JO, STEPHEN H MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85540	04	Otology, Laryngology, Rhinology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
180985	Fee-for-Service	1215256631	1215256631	1	1	JONES, KATRICE DANIELLE	5/16/2010	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14485 SENECA RD	APT #104	VICTORVILLE	CA	92392	9350	36	06071	34.51399053	-117.3479193	San Bernardino County
181177	Fee-for-Service	1205253242	1205253242	1	1	JAIN, NAMITA MD	10/11/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	173501	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
181230	Fee-for-Service	1104212216	1104212216	1	1	JAFRI, SYED S DO	12/17/2019	390200000X	NA	Other	026	PHYSICIANS	17678	13	Neurology (M.D. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
181295	Fee-for-Service	1932490919	1932490919	1	1	JAHANIAN, ARDESHIR MD	7/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123469	05	Anesthesiology	0	In state provider	None	501 SOUTH BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
181383	Fee-for-Service	1386659167	1386659167	1	1	JENNINGS, RAYMOND D MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	20599	41	Internal Medicine	0	In state provider	None	15230 LAKESHORE DRIVE	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
181389	Fee-for-Service	1174776249	1174776249	1	1	JOHNSON, CHRISTINE L LCSW	5/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
181391	Fee-for-Service	1831482371	1831482371	1	1	JACOBSON, DANE MD	3/27/2020	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
181482	Fee-for-Service	1275590267	1275590267	1	2	JOHNSON, MICHAEL W MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63669	08	Family Practice	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
181509	Fee-for-Service	1053692988	1053692988	1	1	JUDY, AMY E MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118200	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
181644	Fee-for-Service	1922048255	1922048255	1	1	JONES, JULIE G LCSW	12/31/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	277 RANCHEROS DR	STE 301	SAN MARCOS	CA	92069	2993	37	06073	33.13859391	-117.1604009	San Diego County
181709	Fee-for-Service	1578736138	1578736138	1	1	JACOBY, RUSSELL F MD	4/2/2008	193400000X	NA	Other	026	PHYSICIANS	86695	10	Gastroenterology (M.D. only)	0	In state provider	OGY A MED CORP	3108 PONTE MORINO DR	STE 230	CAMERON PARK	CA	94682	5022	09	06017	38.66390411	-120.9664367	El Dorado County
181909	Fee-for-Service	1326008764	1326008764	1	1	JOHN MACKENZIE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEW MEXICO HEART INSTI	502 ELM ST NE	None	ALBUQUERQUE	NM	87102	0000	00	None	35.08684897	-106.6377887	Bernalillo County
181940	Fee-for-Service	1629348685	1629348685	1	1	JAGHAB, JUSTIN J MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118599	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
181974	Fee-for-Service	1902122757	1902122757	1	1	JAMORA, CHRISTOPHER K MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118912	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
182023	Fee-for-Service	1861432510	1861432510	1	1	JOHN SHORT	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 MOUNTAIN VIEW DR	None	SHELTON	WA	98584	4401	00	None	47.2267481	-123.1151279	Mason County
182155	Fee-for-Service	1043598741	1043598741	1	1	JOHNSON, MATTHEW S MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117704	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
182185	Fee-for-Service	1609951029	1609951029	2	2	JOE, LORAH L LCSW	1/1/2024	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
182187	Fee-for-Service	1962841940	1962841940	1	1	JHAJ, RUBY K MD	5/26/2020	207R00000X	NA	Other	026	PHYSICIANS	164236	41	Internal Medicine	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
182285	Fee-for-Service	1417392689	1417392689	1	1	JENSEN, ANDREW R MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133993	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
182318	Fee-for-Service	1154378297	1154378297	1	1	JASON KNIGHT MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
182347	Fee-for-Service	1104826700	1104826700	1	1	JONATHAN C ROCK	7/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2380 N 400 E	None	OGDEN	UT	84414	7232	00	None	41.30154184	-111.9687508	Weber County
182380	Fee-for-Service	1013274729	1013274729	1	1	JACOB ORMSRY	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
182494	Fee-for-Service	1083869119	1083869119	1	1	J&J MEDICAL SUPPLY, INC.	11/8/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	1957 HWY 95	STE 5	BULLHEAD CITY	AZ	86442	6744	00	None	35.118783	-114.597405	Mohave County
182503	Fee-for-Service	1528711280	1528711280	1	1	JUAREZ, IRVIN LMFT	3/24/2025	101YM0800X	NA	Other	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
182514	Fee-for-Service	1639189053	1639189053	1	1	JONES, MICHAEL T MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8606	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
182575	Fee-for-Service	1164650206	1164650206	1	1	JUSSAL, TINA	5/5/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2131 SAN JOAQUIN HILLS	None	NEWPORT BEACH	CA	92660	6507	30	06059	33.61632004	-117.8687553	Orange County
182597	Fee-for-Service	1174697072	1174697072	1	1	JOHNSON, DEBRA J MD	3/7/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	48021	24	Plastic Surgery	0	In state provider	None	95 SCRIPPS DR	None	SACRAMENTO	CA	95825	6320	34	06067	38.571831	-121.409604	Sacramento County
182599	Fee-for-Service	1467471920	1467471920	1	1	JAYAPRAKASH D. REDDY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OHSU MEDICAL GROUP	3181 SW SAM JACSON PARK	ROAD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
182634	Fee-for-Service	1427057132	1427057132	1	1	JENKINSON, ERIC J MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135964	None	None	0	In state provider	None	1255 LIBERTY ST	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
182641	Fee-for-Service	1265752331	1265752331	1	1	JOSHUA D STILLEY MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	# SR	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
182717	Fee-for-Service	1205869062	1205869062	1	1	JUNG, BARBARA H MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76125	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
182842	Fee-for-Service	1679083422	1679083422	1	1	JAMES, ALISON V PHD	12/15/2017	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
182849	Fee-for-Service	1649269424	1649269424	1	1	JOHN J. MCGILL, 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	6644 E BAYWOOD AVE	None	MESA	AZ	85206	1747	00	None	33.411159	-111.688686	Maricopa County
182879	Fee-for-Service	1154645703	1154645703	1	1	JAYARAMAN, RAJESWARI MD	7/12/2013	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
182906	Fee-for-Service	1922324789	1922324789	1	1	JENSEN, ROSE C MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143093	None	None	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
182961	Fee-for-Service	1134121874	1134121874	1	1	JOST, 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	6335 E MAIN ST	STE C1	MESA	AZ	85205	8966	00	None	33.414003	-111.694203	Maricopa County
183021	Fee-for-Service	1558758797	1558758797	1	1	JANUSZYK, MICHAEL P MD	8/8/2022	208200000X	NA	General Surgery	026	PHYSICIANS	150169	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
183027	Fee-for-Service	1215992359	1215992359	1	1	JEFFREY FOWLER	3/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
183156	Fee-for-Service	1659824845	1659824845	1	1	JIANG, YIFEI MD	7/22/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
183161	Fee-for-Service	1942627419	1942627419	1	1	JANE P. O'BRIEN CRNA NURSING	12/18/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	SERVICES, INCORPORATED	310 SAGE STREET	None	SAN LUIS OBISPO	CA	93401	6803	40	06079	35.25554446	-120.6645729	San Luis Obispo County
183437	Fee-for-Service	1689721789	1689721789	1	1	JOBES, JUDY K OD	1/21/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
183444	Fee-for-Service	1356101604	1356101604	1	1	JOHNSON, MARY E DOULA	4/10/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
183564	Fee-for-Service	1184041147	1184041147	1	1	JASUJA, SONIA MD	6/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140210	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
183623	Fee-for-Service	1902877103	1902877103	1	1	JOHN GERARD SCHREUDER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9675 SE 36TH ST	None	MERCER ISLAND	WA	98040	3723	00	None	47.57777663	-122.2092031	King County
183635	Fee-for-Service	1013006998	1013006998	1	1	JAVERBAUM, JEFFREY MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	33682	13	Neurology (M.D. only)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
183674	Fee-for-Service	1770815995	1770815995	1	1	JONES, BRIAN E	11/4/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
183678	Fee-for-Service	1629084264	1629084264	1	1	JOSEPH-BROWN, DENISE MD INC	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66679	02	General Surgery	0	In state provider	None	5122 KATELLA AVENUE	STE 220	LOS ALAMITOS	CA	90720	6836	30	06059	33.80290311	-118.0433422	Orange County
183701	Fee-for-Service	1063528362	1063528362	1	1	JOHNSON, RICHARD O MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	29540	40	Pediatrics	0	In state provider	None	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
183719	Fee-for-Service	1477294346	1477294346	1	1	JASINSKI, GEOFFREY G PT	10/5/2022	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
183781	Fee-for-Service	1619905924	1619905924	1	1	JEFFREY REX BRACE MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
183898	Fee-for-Service	1003857145	1003857145	1	1	JEFFREY HOWARD, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	0000	00	None	47.052801	-122.847462	Thurston County
183903	Fee-for-Service	1902651920	1902651920	1	1	JOURNEY THERAPEUTICS MARRIAG	5/31/2024	225XM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27660 MERIDIAN ST	None	HEMET	CA	92544	8370	33	06065	33.72052855	-116.9279925	Riverside County
183907	Fee-for-Service	1447287263	1447287263	1	1	JAMES,RANDY 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	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
183933	Fee-for-Service	1750388195	1750388195	2	1	JONES, RICHARD F DO	7/21/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	5831	08	Family Practice	0	In state provider	None	18660 OUTER HIGHWAY 18	None	APPLE VALLEY	CA	92307	2316	36	06071	34.53882192	-117.2572076	San Bernardino County
183986	Fee-for-Service	1063528362	1063528362	1	1	JOHNSON, RICHARD O MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
184030	Fee-for-Service	1255375705	1255375705	1	1	JOHNSON, MEADE MD	3/31/1991	2085B0100X	NA	MRI Provider	026	PHYSICIANS	45908	01	General Practice	0	In state provider	USC RADIOLOGY ASSOCIATES	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
184042	Fee-for-Service	1831252808	1831252808	1	1	J. BECK AND D. YOUNG ODS	8/8/1995	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2074 LAKE TAHOE BLVD	STE 2	SOUTH LAKE TAHOE	CA	96150	6408	09	06017	38.91488542	-120.0019087	El Dorado County
184101	Fee-for-Service	1649204579	1649204579	1	1	JOHNSONS ORTHOPEDIC OF	12/7/2004	174400000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	5482 COMPLEX STREET	SUITE 106	SAN DIEGO	CA	92123	1125	37	06073	32.83381695	-117.1346166	San Diego County
184118	Fee-for-Service	1407997067	1407997067	1	1	JONBEC CARE, INC	6/26/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BRYANT HOUSE	906 BRYANT ST	None	CALIMESA	CA	92320	1302	33	06065	34.004511	-117.034558	Riverside County
184125	Fee-for-Service	1235669409	1235669409	1	1	JOY, LISA	6/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
184133	Fee-for-Service	1972036879	1972036879	1	1	JAYAKUMAR, PRIYANGA MD MPH	3/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166928	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
184140	Fee-for-Service	1538209127	1538209127	1	1	JONBEC CARE, INC	12/1/1996	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ROSEBUD	1956 HARDT ST	None	LOMA LINDA	CA	92354	1726	36	06071	34.07112388	-117.2451416	San Bernardino County
184218	Fee-for-Service	1154422111	1154422111	2	1	J&J RX	7/18/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	403 W. F STREET	None	ONTARIO	CA	91762	3207	36	06071	34.069293	-117.655065	San Bernardino County
184266	Fee-for-Service	1922042340	1922042340	1	1	JACOBSEN, RAYN 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	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
184271	Fee-for-Service	1851381081	1851381081	1	1	JUELL, BRIAN E MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6554 S MCCARRAN BLVD	STE B	RENO	NV	89509	6149	00	None	39.47663442	-119.7992969	Washoe County
184303	Fee-for-Service	1841583267	1841583267	1	1	JARCIA, CECILIA J MD	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129483	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
184391	Fee-for-Service	1225231749	1225231749	1	1	JEFFREY WRIGHT, 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 SOUTH PIONEER	PARKWAY	SALT LAKE CITY	UT	84109	3050	00	None	40.69731702	-111.8208501	Salt Lake County
184428	Fee-for-Service	1093792640	1093792640	1	1	JACOB, RICHARD MD	12/1/1977	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22936	41	Internal Medicine	0	In state provider	None	27856 PUERTA REAL 126	None	MISSION VIEJO	CA	92675	0000	30	06059	33.56849493	-117.6696298	Orange County
184485	Fee-for-Service	1639665631	1639665631	1	1	JAGANATHAN, ABILASH MD	8/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174142	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
184513	Fee-for-Service	1285044925	1285044925	1	1	JUN, JENNY A MD	12/1/2020	207RR0500X	NA	Other	026	PHYSICIANS	141746	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
184765	Fee-for-Service	1700079191	1700079191	1	1	JAKUBANIS, BETH A LCSW	10/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
184794	Fee-for-Service	1023137486	1023137486	1	1	JAFREY, SUHAIL M MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
184795	Fee-for-Service	1770651291	1770651291	1	1	JACKSON, PAUL S MD	2/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85830	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
184799	Fee-for-Service	1619622636	1619622636	1	1	JENNIFER COBANOV, MD PROFESS	7/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	10459 MOUNTAIN VIEW AVE	STE F	LOMA LINDA	CA	92354	2033	36	06071	34.063722	-117.2436545	San Bernardino County
184881	Fee-for-Service	1578854899	1578854899	1	1	JACKSON HENLEY	12/26/2016	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
184901	Fee-for-Service	1194008367	1194008367	1	1	JOSHI, AMBRISHA MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112114	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
184962	Fee-for-Service	1720070170	1720070170	1	1	JELCZ, MARION 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	2650 RIDGE AVE	None	EVANSTON	IL	60201	1718	00	None	42.06623373	-87.68310622	Cook County
184966	Fee-for-Service	1003941766	1003941766	1	1	JACOBSEN, CARL H OD	5/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
185007	Fee-for-Service	1992754535	1992754535	1	1	JOEL M CLINGENPEEL, M.D	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
185059	Fee-for-Service	1790084010	1790084010	1	1	JOHN, THEODORE MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143051	02	General Surgery	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
185075	Fee-for-Service	1285067991	1285067991	1	1	JONES, PHILLIP E MD INC	10/7/2013	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	120284	20	Orthopedic Surgery	0	In state provider	None	6127 CLARK RD	STE 200	PARADISE	CA	95969	4177	04	06007	39.76304842	-121.6042302	Butte County
185381	Fee-for-Service	1700927902	1700927902	1	1	JENNIFER GRAY, MD	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 STATE STREET	None	MCCALL	ID	83638	0000	00	None	44.90904704	-116.1097318	Valley County
185469	Fee-for-Service	1316332026	1316332026	1	1	JONES, CARRIE DO	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	22981	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
185539	Fee-for-Service	1861793721	1861793721	1	1	JOY-HAWKINS, TAMEKA M NP	10/13/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
185591	Fee-for-Service	1689080525	1689080525	1	1	JOHNSON, ERIC J DO	10/3/2022	208600000X	NA	General Surgery	026	PHYSICIANS	19889	None	None	0	In state provider	None	2580 SISTER MARY COLUMBA	STE 200	RED BLUFF	CA	96080	4327	52	06103	40.14842672	-122.2180085	Tehama County
185664	Fee-for-Service	1952320350	1952320350	1	1	JOHNSON, ELLEN D MD	1/23/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183837	None	None	0	In state provider	None	2975 SYCAMORE DRIVE	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
185714	Fee-for-Service	1245624436	1245624436	1	1	JOHNSON, THOMAS E MD	7/21/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169018	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
185756	Fee-for-Service	1316332026	1316332026	1	1	JONES, CARRIE DO	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	22981	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
185786	Fee-for-Service	1164490298	1164490298	1	1	JAMES RICHARD WOLSKI, 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	3801 S NATIONAL	None	SPRINGFIELD	MO	65807	5210	00	None	37.1451107	-93.27863681	Greene County
185797	Fee-for-Service	1801232731	1801232731	1	1	JOHN, DON MD	10/17/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156442	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
185836	Fee-for-Service	1629155692	1629155692	1	1	JOHNSON, DAWN MD	7/10/2023	208600000X	NA	General Surgery	026	PHYSICIANS	186793	None	None	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
185882	Fee-for-Service	1811213382	1811213382	1	1	JILK, JASON W MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120460	41	Internal Medicine	0	In state provider	None	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
185889	Fee-for-Service	1396793717	1396793717	1	1	JACOBS,YOUHANA T MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75611	41	Internal Medicine	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
185930	Fee-for-Service	1235332206	1235332206	1	1	JOSEPHAT NGATIA M.D	6/29/2016	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
185976	Fee-for-Service	1396835153	1396835153	1	1	JOSEPH, JAY S MD	6/30/1991	2085R0001X	NA	Other	026	PHYSICIANS	74799	None	None	0	In state provider	None	1 CENTRAL AVE	None	SAN FRANCISCO	CA	94117	4114	38	06075	37.7690226	-122.443365	San Francisco County
186099	Fee-for-Service	1487378469	1487378469	1	1	JOY LUCK ACUPUNCTURE WELLNES	2/1/2023	261QP0905X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	948 DOLORES AVE	None	LOS ALTOS	CA	94024	6010	43	06085	37.35424447	-122.088402	Santa Clara County
186109	Fee-for-Service	1417764432	1417764432	1	1	JOHNSON, REGINA	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	19	06037	0	0	None
186170	Fee-for-Service	1497984314	1497984314	1	1	JAIN, JYOTI MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108251	36	Psychiatry	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
186183	Fee-for-Service	1528326873	1528326873	1	1	JACOB J MILLER	11/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3015 3RD AVE SE	None	ABERDEEN	SD	57401	5418	00	None	45.46218051	-98.444655	Brown County
186277	Fee-for-Service	1124091970	1124091970	1	1	JACKSON, KEITH A MD	5/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58187	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
186419	Fee-for-Service	1336691740	1336691740	1	1	JILIN BAI MD PROFESSIONAL CO	10/2/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	RPORATION	223 N. GARFIELD AVE	202	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
186442	Fee-for-Service	1598576100	1598576100	1	1	JS WOUND CARE INC	4/14/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	25050 PEACHLAND AVE	STE 255	NEWHALL	CA	91321	5761	19	06037	34.37812733	-118.5467925	Los Angeles County
186498	Fee-for-Service	1336145051	1336145051	1	1	JANOUSEK, T STEVEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2855 CAMPUS DR SUITE 570	None	PLYMOUTH	MN	55441	2688	00	None	45.01182745	-93.45315409	Hennepin County
186570	Fee-for-Service	1598191900	1598191900	1	1	JAVED, LAILA MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145519	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
186730	Fee-for-Service	1922402700	1922402700	1	1	JACOBSON, CATHLEEN LMFT	5/5/2022	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 QUAIL ST	SUITE 160	NEWPORT BEACH	CA	92660	2721	30	06059	33.65915099	-117.8659973	Orange County
186792	Fee-for-Service	1518187236	1518187236	1	1	JOY, JOCELYN N LAC	8/21/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4420 HOTEL CIRCLE CT	265	SAN DIEGO	CA	92108	3434	37	06073	32.75818782	-117.1746702	San Diego County
186980	Fee-for-Service	1043244122	1043244122	1	1	JOHN, THAMPI K MD INC	1/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52031	41	Internal Medicine	0	In state provider	None	30 RIVER PARK PL W	STE 330	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
187066	Fee-for-Service	1144210147	1144210147	1	1	JULIAN CUYAMACA FIRE	5/9/1998	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PROTECTION DIST	2645 FARMER RD	None	JULIAN	CA	92036	0033	37	06073	33.08013834	-116.6045261	San Diego County
187168	Fee-for-Service	1821529512	1821529512	1	1	JOYO, ERI E MD	8/10/2022	207R00000X	NA	Other	026	PHYSICIANS	158584	None	None	0	In state provider	None	5800 HOLLIS ST	None	EMERYVILLE	CA	94608	2016	01	06001	37.84043576	-122.2894291	Alameda County
187206	Fee-for-Service	1669712246	1669712246	1	1	JEMERA, JOSEPH M	4/2/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
187266	Fee-for-Service	1043244122	1043244122	1	1	JOHN, THAMPI K MD INC	1/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52031	66	Emergency Medicine (Urgent Care)	0	In state provider	None	30 RIVER PARK PL W	STE 330	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
187445	Fee-for-Service	1649282161	1649282161	1	1	JOHNSON, JAMES L MD	7/31/1996	207L00000X	NA	Other	026	PHYSICIANS	80987	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
187457	Fee-for-Service	1851617211	1851617211	1	1	JONES, COURTNEY L DO	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12010	40	Pediatrics	0	In state provider	None	1640 NEWPORT BLVD	STE 210	COSTA MESA	CA	92627	3781	30	06059	33.63437128	-117.9221659	Orange County
187466	Fee-for-Service	1801437736	1801437736	1	1	JUDITH WESTON-THOMPSON LICEN	10/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SED MARRIAGE AND FAMILY	700 E ST	205	SAN RAFAEL	CA	94901	2782	21	06041	37.97112293	-122.533553	Marin County
187493	Fee-for-Service	1972665438	1972665438	1	1	JEANNE DECARA	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
187521	Fee-for-Service	1588318703	1588318703	1	1	JIE SHI YAN, M.D., INC	4/19/2022	261Q00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	680 COLORADO BLVD	SUITE 180	PASADENA	CA	91101	6143	19	06037	34.14586451	-118.136493	Los Angeles County
187544	Fee-for-Service	1861571531	1861571531	1	1	JOHNSON, STEVEN A MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79443	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
187547	Fee-for-Service	1356358311	1356358311	1	1	JONATHAN L. MARINARO MD	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
187551	Fee-for-Service	1578532131	1578532131	2	1	JIMENEZ, ARTHUR E MD	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64270	None	None	0	In state provider	None	15381 7TH ST	STE 2-3	VICTORVILLE	CA	92395	3803	36	06071	34.53171716	-117.2981568	San Bernardino County
187556	Fee-for-Service	1043244122	1043244122	1	1	JOHN, THAMPI K MD INC	1/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52031	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	30 RIVER PARK PL W	STE 330	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
187565	Fee-for-Service	1093861676	1093861676	1	1	JOHNSTON, JENNIFER H T MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136947	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
187674	Fee-for-Service	1497094155	1497094155	1	1	JOHNSON, TODD J 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
187709	Fee-for-Service	1922072404	1922072404	1	2	JAN, ALTAF MD	11/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52866	10	Gastroenterology (M.D. only)	0	In state provider	None	2801 K ST	None	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
187855	Fee-for-Service	1215228820	1215228820	1	1	JODHKA, FELICIA K MD	7/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115749	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
188028	Fee-for-Service	1174508865	1174508865	1	1	JOHNSON, ALFRED B MD	1/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88950	02	General Surgery	0	In state provider	None	315 MERCY AVE	SUITE 400	MERCED	CA	95340	8368	24	06047	37.33874349	-120.467493	Merced County
188030	Fee-for-Service	1417718081	1417718081	1	1	J. MOUCHARRAFIE, MD, INC.	6/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1781 W ROMNEYA DR	STE E	ANAHEIM	CA	92801	1818	30	06059	33.85067272	-117.9447342	Orange County
188070	Fee-for-Service	1215000526	1215000526	1	1	JOHNSTONE, ANNE K MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81207	84	Surgery-Head and Neck	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
188248	Fee-for-Service	1477073369	1477073369	1	1	JOHNSON, KRISTOPHER P MD	5/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	157251	05	Anesthesiology	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
188257	Fee-for-Service	1639543390	1639543390	1	1	JENNIFER BLUM PSYD LICENSED	9/24/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D PSYCHOLOGIST, PC	1144 SONOMA AVE	SUITE 104	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
188282	Fee-for-Service	1750647319	1750647319	1	1	JOHNSON, LEONIDAS A OD A	7/2/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORP	8615 KNOTT AVE	SUITE 9	BUENA PARK	CA	90620	3800	30	06059	33.83765695	-118.0111408	Orange County
188283	Fee-for-Service	1184691974	1184691974	1	1	JAIN, SUNITA MD	8/24/2004	193400000X	NA	Other	026	PHYSICIANS	51200	89	Surgery-Traumatic	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
188290	Fee-for-Service	1376181461	1376181461	1	1	JANETS ENTERPRISE INC	7/9/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8271 ONYX CT	None	RANCHO CUCAMONGA	CA	91730	3542	36	06071	34.10338852	-117.6007982	San Bernardino County
188388	Fee-for-Service	1689974255	1689974255	1	1	JO, MARK J MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122314	None	None	0	In state provider	None	10 CONGRESS ST #103	None	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
188444	Fee-for-Service	1093134330	1093134330	1	1	JOEL, IAN D MD	8/18/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	143069	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
188485	Fee-for-Service	1710590971	1710590971	1	1	JAVIER R RIOS MD, A PROFESSI	7/12/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6926 BROCKTON AVE	STE 7	RIVERSIDE	CA	92506	3804	33	06065	33.947919	-117.3967225	Riverside County
188546	Fee-for-Service	1518034115	1518034115	2	1	JAHANPANAH, FERESHTEH MD	3/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65104	41	Internal Medicine	0	In state provider	APMC	1319 E MAIN STREET	None	EL CAJON	CA	92022	1626	37	06073	32.79692657	-116.9339111	San Diego County
188553	Fee-for-Service	1134383391	1134383391	1	1	JANATPOUR, NINA S MD	1/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103294	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
188571	Fee-for-Service	1184691974	1184691974	1	1	JAIN, SUNITA MD	8/24/2004	193400000X	NA	Other	026	PHYSICIANS	51200	41	Internal Medicine	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
188714	Fee-for-Service	1811599707	1811599707	1	1	JIANG, MAMIE CRNA	6/1/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
188719	Fee-for-Service	1144603358	1144603358	1	1	JALALI, NIMA MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	160549	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
188723	Fee-for-Service	1669625729	1669625729	1	1	JOSEPH, MICHAL	2/10/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1035 GRAYSON STREET	None	BERKELEY	CA	94710	0000	01	06001	37.85605581	-122.2888417	Alameda County
188931	Fee-for-Service	1083049860	1083049860	1	1	JOHNSON, ALEXANDER L MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144149	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
189030	Fee-for-Service	1063528362	1063528362	1	2	JOHNSON, RICHARD O MD MPH	7/30/2019	208000000X	NA	Pediatric Primary Care	086	MEDICAL DIRECTORS	29540	-	NOT APPLICABLE	0	In state provider	None	75 DIAMOND VALLEY RD	UNIT C	MARKLEEVILLE	CA	96120	9532	02	06003	38.76971302	-119.8167951	Alpine County
189194	Fee-for-Service	1376601443	1376601443	1	1	JACK, ROBERT L MD	12/1/1987	174400000X	NA	Other	026	PHYSICIANS	17236	18	Ophthalmology	0	In state provider	None	1225 CRANE ST	STE 202	MENLO PARK	CA	94025	4253	41	06081	37.45227837	-122.187316	San Mateo County
189207	Fee-for-Service	1558392704	1558392704	1	1	JONES, EDWARD C MD	1/8/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	152622	77	Infectious Disease	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
189354	Fee-for-Service	1538185368	1538185368	1	2	JUDD, PATRICIA PHD	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	12952	-	NOT APPLICABLE	0	In state provider	None	140 ARBOR DR	None	SAN DIEGO	CA	92103	2007	37	06073	32.75382424	-117.1635451	San Diego County
189450	Fee-for-Service	1285033936	1285033936	1	1	JOHN, HARSHA	11/7/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
189477	Fee-for-Service	1275160954	1275160954	1	1	JOUHARIAN, POUYA MD	7/21/2023	1835E0208X	NA	None	026	PHYSICIANS	185083	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
189486	Fee-for-Service	1386180693	1386180693	1	1	JEU, ANGIE CCC-SLP	4/22/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
189490	Fee-for-Service	1134492069	1134492069	1	1	JACKSON, STEVEN	5/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52239	-	NOT APPLICABLE	0	In state provider	None	104 W 4TH ST	None	SAN BERNARDINO	CA	92415	0035	36	06071	34.1064933	-117.285246	San Bernardino County
189535	Fee-for-Service	1457370397	1457370397	1	1	JONES, JOHN S MD	1/1/1979	207P00000X	NA	Other	026	PHYSICIANS	29992	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1890 DEODORA ST	None	SIMI VALLEY	CA	93065	3925	56	06111	34.27047313	-118.7377576	Ventura County
189537	Fee-for-Service	1043403207	1043403207	1	1	JULIAN, ROBERT S DDS MD INC	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63994	02	General Surgery	0	In state provider	None	290 N WAYTE LNE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
189822	Fee-for-Service	1457370397	1457370397	1	1	JONES, JOHN S MD	1/1/1979	207P00000X	NA	Other	026	PHYSICIANS	29992	41	Internal Medicine	0	In state provider	None	1890 DEODORA ST	None	SIMI VALLEY	CA	93065	3925	56	06111	34.27047313	-118.7377576	Ventura County
189864	Fee-for-Service	1780709394	1780709394	1	1	JOHNSON, JASON D DO	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 190	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
189882	Fee-for-Service	1861768863	1861768863	1	1	JORDAN, ERIC J MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128542	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
189957	Fee-for-Service	1245324201	1245324201	1	1	JENGO, JAMES A MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24864	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1045 ATLANTIC AVE	STE 91	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
190076	Fee-for-Service	1417108358	1417108358	1	1	JANDIAL, RAHUL MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77673	14	Neurological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
190104	Fee-for-Service	1437610573	1437610573	1	1	JOHNSON, KIMBERLY MD	7/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178634	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
190140	Fee-for-Service	1144267188	1144267188	1	1	JIMENEZ-GRILLO, CARLOS E MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53456	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
190252	Fee-for-Service	1699810408	1699810408	1	1	JANSEN, WOUTER N H LCSW	6/17/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26844	-	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
190274	Fee-for-Service	1679787311	1679787311	1	1	JOANNE S LEE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
190394	Fee-for-Service	1770643702	1770643702	1	1	J D MEDICAL TRANSPORT	4/8/1996	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	1013 E LURAY ST	None	LONG BEACH	CA	90807	1019	19	06037	33.84560185	-118.1815879	Los Angeles County
190395	Fee-for-Service	1962066324	1962066324	1	1	JOANNA ZIONI, MARRIAGE AND F	9/4/2019	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AMILY THERAPY, INC	24405 CHESTNUT STREET	SUITE 205	NEWHALL	CA	91321	2852	19	06037	34.37967818	-118.531332	Los Angeles County
190550	Fee-for-Service	1568419588	1568419588	1	1	JODHANI, MADHU MD	11/20/2009	174400000X	NA	Other	026	PHYSICIANS	50459	78	Neoplastic Diseases/Oncology	0	In state provider	None	481 PLUMAS BLVD	STE 102	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
190579	Fee-for-Service	1689809394	1689809394	1	1	JOHNSON, DEANNE E PHD	1/9/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	D THERAPY/PATH	701 GARDEN VIEW CT	22	ENCINITAS	CA	92024	2464	37	06073	33.05846143	-117.2599332	San Diego County
190584	Fee-for-Service	1376766238	1376766238	1	2	J COLE RECOVERY HOMES, INC	12/13/2024	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	18 W 15TH ST	None	ANTIOCH	CA	94509	2318	07	06013	38.00750255	-121.8066947	Contra Costa County
190611	Fee-for-Service	1003053851	1003053851	1	1	JENG, AARON I MD	10/18/2010	207R00000X	NA	Other	026	PHYSICIANS	106414	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
190612	Fee-for-Service	1376930677	1376930677	1	1	JAWED, YAMEENA T MD	4/15/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	171553	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
190780	Fee-for-Service	1780010603	1780010603	1	1	JOHNSON, CONNOR V MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138799	41	Internal Medicine	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
190845	Fee-for-Service	1720098387	1720098387	2	1	JAIN, ASHIT MD INC	8/23/2004	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	27200 CALAROGA AVENUE	None	HAYWARD	CA	94538	4383	01	06001	37.63347961	-122.0897735	Alameda County
190945	Fee-for-Service	1093737801	1093737801	1	1	JUNG, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66105	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
190969	Fee-for-Service	1093782575	1093782575	1	1	JATI, ANUBHA	8/19/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	135645	None	None	0	In state provider	None	2800 L ST	STE 10	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
191003	Fee-for-Service	1730294844	1730294844	1	1	JAGDISH B PATEL M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CLINIC DEGESTIVE DISES	13203 N 103RD AVE STE C3	None	SUN CITY	AZ	85351	3099	00	None	33.604128	-112.2798915	Maricopa County
191046	Fee-for-Service	1811060825	1811060825	1	1	JOHNSON, RONLAD 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	608 N KEY AVE	None	LAMPASAS	TX	76550	1106	00	None	31.07243105	-98.18564889	Lampasas County
191059	Fee-for-Service	1134212301	1134212301	1	1	JAY HOCHSZTEIN	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
191113	Fee-for-Service	1144385964	1144385964	1	1	JONES, JEFFRY H MD INC	11/1/2001	193200000X	NA	Other	026	PHYSICIANS	81725	41	Internal Medicine	0	In state provider	None	500 UNIVERSITY AVE	STE 260	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
191135	Fee-for-Service	1720098387	1720098387	2	1	JAIN, ASHIT MD INC	8/23/2004	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	27200 CALAROGA AVENUE	None	HAYWARD	CA	94538	4383	01	06001	37.63347961	-122.0897735	Alameda County
191162	Fee-for-Service	1093923922	1093923922	1	1	JUSTICE-ROYSTER, VELMA LMFT	1/9/2025	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
191279	Fee-for-Service	1518311091	1518311091	1	1	JREIJE, KARIM DO	8/10/2021	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	16527	None	None	0	In state provider	None	300 HILLMONT AVE STE 401	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
191327	Fee-for-Service	1033163266	1033163266	1	1	JEFF THORNTON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LIBERTY NEUROLOGY LLC	2525 GLENN HENDREN DR	None	LIBERTY	MO	64068	0000	00	None	39.278767	-94.42102759	Clay County
191359	Fee-for-Service	1528268679	1528268679	1	1	JAVED, RANA A MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99876	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
191403	Fee-for-Service	1144385964	1144385964	1	1	JONES, JEFFRY H MD INC	11/1/2001	193200000X	NA	Other	026	PHYSICIANS	81725	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	STE 260	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
191513	Fee-for-Service	1235787235	1235787235	1	1	JOYCE, TARYN A NP	11/10/2023	364SP0809X	NA	Other	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
191537	Fee-for-Service	1891873634	1891873634	1	1	JENSEN, GEORGINA MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67343	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
191562	Fee-for-Service	1225322480	1225322480	1	1	JINDAL, PARUL MD	6/14/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	147151	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
191586	Fee-for-Service	1871915900	1871915900	1	1	JONES, JESSICA LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1611 BOREL PL	5	SAN MATEO	CA	94402	3503	41	06081	37.54910794	-122.3179498	San Mateo County
191608	Fee-for-Service	1902954134	1902954134	1	1	JUNG, PETER B OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	20790 MADRONA AVE	None	TORRANCE	CA	90503	3777	19	06037	33.84145481	-118.344603	Los Angeles County
191609	Fee-for-Service	1497035786	1497035786	1	1	JUAN PABLO SANCHEZ 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
191661	Fee-for-Service	1205149077	1205149077	1	1	JARDINI, TRISTAN A MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113171	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
191668	Fee-for-Service	1215613070	1215613070	1	1	JENKIN, DIANE A MSW LCSW	8/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4310 BLACKHAWK ST	None	CHOWCHILLA	CA	93610	8470	20	06039	37.1235517	-120.2367868	Madera County
191696	Fee-for-Service	1972626364	1972626364	1	1	JENKINS, PAMELA A	6/25/2010	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
191708	Fee-for-Service	1497445043	1497445043	1	1	JOHNSON, MARI PT	10/18/2023	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
191741	Fee-for-Service	1902487440	1902487440	1	1	JOHNSON, MACEY MD	7/21/2024	207P00000X	NA	Other	026	PHYSICIANS	186559	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
191749	Fee-for-Service	1265016612	1265016612	1	1	JACOBS, ALEXANDRA A DPM	8/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	300 N EUCLID ST	STE A	FULLERTON	CA	92832	1623	30	06059	33.87250373	-117.9419615	Orange County
191780	Fee-for-Service	1902873805	1902873805	1	1	JONES, MARY K MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41135	01	General Practice	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
191812	Fee-for-Service	1528264710	1528264710	1	1	JUHL, JERRY F	10/4/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	46-900 MONROE ST	None	INDIO	CA	92201	4829	33	06065	33.70748774	-116.2338705	Riverside County
191838	Fee-for-Service	1164460572	1164460572	1	1	JOYNER, MARK H. MD	5/31/1992	207P00000X	NA	Other	026	PHYSICIANS	50717	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6700 S CENTINELA AVE	STE 300	CULVER CITY	CA	90230	6347	19	06037	33.98373559	-118.4045944	Los Angeles County
191839	Fee-for-Service	1346221116	1346221116	1	1	JOSE IGLESIAS	12/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
191912	Fee-for-Service	1841338209	1841338209	1	1	JORDAN, JENNIFER LMFT	9/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 E GRAND BLVD	STE E	CORONA	CA	92879	2226	33	06065	33.87371531	-117.5590226	Riverside County
192006	Fee-for-Service	1417664715	1417664715	1	1	J TRAN FAMILY CARE INC	12/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1855 ALUM ROCK AVE	STE C	SAN JOSE	CA	95116	1398	43	06085	37.35399602	-121.8531134	Santa Clara County
192068	Fee-for-Service	1902873805	1902873805	1	1	JONES, MARY K MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41135	41	Internal Medicine	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
192080	Fee-for-Service	1447241336	1447241336	1	1	JAY, PATRICK Y. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	None	SAINT LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
192132	Fee-for-Service	1871561670	1871561670	1	1	JOHNSON, CRAIG E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86787	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A PROFESSIONAL CORP	2299 MOWRY AVE	FL 2A	FREMONT	CA	94538	1638	01	06001	37.55671415	-121.9817758	Alameda County
192154	Fee-for-Service	1346329919	1346329919	1	1	JAMES P EDLIN, 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
192200	Fee-for-Service	1154519015	1154519015	1	1	JANRAY HOME INC	10/29/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12921 BIOLA AVE	None	LA MIRADA	CA	90638	2104	19	06037	33.91361202	-118.020291	Los Angeles County
192268	Fee-for-Service	1295948727	1295948727	1	1	JOHSENS, KARL K MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84030	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
192270	Fee-for-Service	1760475701	1760475701	1	1	JABARA, AMER E MD	11/30/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	69806	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
192408	Fee-for-Service	1043691421	1043691421	1	1	JONES, ANDREW D MD	9/24/2024	207ZP0105X	NA	Other	026	PHYSICIANS	145090	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
192431	Fee-for-Service	1780669127	1780669127	1	1	JESS FIEDOROWICZ MD	2/14/2013	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
192432	Fee-for-Service	1588735815	1588735815	1	1	JEFFREY J BROWN MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3635 VISTA AVE	None	SAINT LOUIS	MO	63110	2539	00	None	38.62249413	-90.23900688	St. Louis city
192532	Fee-for-Service	1215078076	1215078076	1	1	JULIA L HUMPHREY, MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
192546	Fee-for-Service	1558758383	1558758383	2	1	JOHN LEE M.D. SLEEP CENTER I	12/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	NC.	500 S. VIRGIL AVE	202	LOS ANGELES	CA	90020	1448	19	06037	34.064964	-118.2870335	Los Angeles County
192560	Fee-for-Service	1760475701	1760475701	1	1	JABARA, AMER E MD	11/30/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	69806	45	Nephrology (Renal-Kidney)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
192600	Fee-for-Service	1952854010	1952854010	1	1	JOHNSON, MATTHEW A	9/16/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
192645	Fee-for-Service	1952465361	1952465361	1	1	JAVID, YAMINALI M MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46602	40	Pediatrics	0	In state provider	None	200 JOSE FIGUERES AVE	STE 320	SAN JOSE	CA	95116	1590	43	06085	37.36122014	-121.8505998	Santa Clara County
192661	Fee-for-Service	1912081134	1912081134	2	1	JENSEN, JANINE K MD	8/9/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2880 ATLANTIC AVE	STE 200	LONG BEACH	CA	90806	1744	19	06037	33.809382	-118.185001	Los Angeles County
192700	Fee-for-Service	1275502825	1275502825	1	1	JENKINS, RICK L MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69736	None	None	0	In state provider	None	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	48	06095	38.23737478	-122.0676832	Solano County
192762	Fee-for-Service	1134213507	1134213507	1	1	JANET L BLANCHARD	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNM LOMAS BLVD NE	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
192773	Fee-for-Service	1962768671	1962768671	1	1	JAYACHANDRAN, PRIYA MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127648	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
192790	Fee-for-Service	1922484609	1922484609	1	1	JAUREGUI-GOMEZ, MONICA A LCS	6/28/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E. CARNEGIE DRIVE	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
192913	Fee-for-Service	1861453771	1861453771	1	1	JEFFREY J LISKO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5705 W OLDSHAKOPEE RD	STE 150	BLOOMINGTON	MN	55437	3126	00	None	44.80775241	-93.35579789	Hennepin County
192950	Fee-for-Service	1912081134	1912081134	2	1	JENSEN, JANINE K MD	1/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68328	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2880 ATLANTIC AVE	STE 200	LONG BEACH	CA	90806	1744	19	06037	33.809382	-118.185001	Los Angeles County
193037	Fee-for-Service	1194164707	1194164707	1	1	JAIN, AMIT K MD	12/2/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	141084	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
193159	Fee-for-Service	1659371946	1659371946	1	1	JACOBS, LAURA O MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4330 MEDICAL DR, STE 500	None	SAN ANTONIO	TX	78229	0000	00	None	29.51083557	-98.57095526	Bexar County
193223	Fee-for-Service	1245764349	1245764349	1	1	JOHAL, JASMYN K MD	9/24/2024	163WR1000X	NA	Other	026	PHYSICIANS	157037	70	Clinic (mixed specialty)	0	In state provider	None	39650 LIBERTY ST	420	FREMONT	CA	94538	2223	01	06001	37.54662058	-121.9736002	Alameda County
193312	Fee-for-Service	1841799103	1841799103	1	1	JOHNSON, JESSY M NP	7/26/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 E LATHAM AVE	STE B	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
193347	Fee-for-Service	1679597181	1679597181	1	1	JARMAKANI, JAY M MD	10/30/1992	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25861	40	Pediatrics	0	In state provider	UCLA PROF SVCS OFF	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
193391	Fee-for-Service	1932393659	1932393659	1	1	JAVAHERI, ATOOSA PSY	10/2/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
193493	Fee-for-Service	1912358540	1912358540	1	1	JADHAW, NISHA MD	12/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158245	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
193509	Fee-for-Service	1245764349	1245764349	1	1	JOHAL, JASMYN K MD	9/24/2024	163WR1000X	NA	Other	026	PHYSICIANS	157037	67	Endocrinology	0	In state provider	None	39650 LIBERTY ST	420	FREMONT	CA	94538	2223	01	06001	37.54662058	-121.9736002	Alameda County
193543	Fee-for-Service	1013129329	1013129329	1	1	JOHN MAXWELL CARMENT, 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 S UTICA AVE	None	TULSA	OK	74104	4012	00	None	36.14680804	-95.96713336	Tulsa County
193608	Fee-for-Service	1154375566	1154375566	2	1	JENG, SHYUN MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53363	18	Ophthalmology	0	In state provider	None	4201 TORRANCE BLVD	SUITE 720	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
193625	Fee-for-Service	1124075346	1124075346	1	1	JACKSON-TRICHE, MAGA E MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	30401	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
193630	Fee-for-Service	1558880260	1558880260	1	1	JACOB JOSEPH AND JABEZ FAMIL	11/6/2018	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COUNSELING AND PROFESS	275 W HOSPITALITY LN	325	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
193635	Fee-for-Service	1184885543	1184885543	1	1	JOSHUA WILLIAM RAMPTON MD	11/29/2015	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
193720	Fee-for-Service	1144340746	1144340746	1	1	JAN & GAIL'S HOMES INC	2/1/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3345 W MONTE VISTA CT	None	VISALIA	CA	93277	7117	54	06107	36.304551	-119.328066	Tulare County
193760	Fee-for-Service	1346820230	1346820230	1	1	JANJI, GEORGE DC	3/18/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	225 GLENOAKS BLVD	None	BURBANK	CA	91502	1317	19	06037	34.18412164	-118.3075846	Los Angeles County
193770	Fee-for-Service	1811670615	1811670615	1	1	JIKAMO, KIFLE G NP	5/5/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
193785	Fee-for-Service	1962415588	1962415588	1	1	JUNG, SUSAN C MD	8/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85542	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
193798	Fee-for-Service	1376069427	1376069427	1	1	JAMES PAK MD INCORPORATED	10/22/2020	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	900 HYDE ST.	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
193841	Fee-for-Service	1851983662	1851983662	1	1	JEREMY V GOMER MD PHD PROFES	4/30/2021	261Q00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 WESTERN	103	SAN BERNARDINO	CA	92411	1352	36	06071	34.1315778	-117.3182453	San Bernardino County
193886	Fee-for-Service	1326087875	1326087875	1	1	JOSEPH, LERLA G MD	6/29/2023	207R00000X	NA	Other	026	PHYSICIANS	184212	None	None	0	In state provider	None	333 W EL CAMINO REAL	STE 230	SUNNYVALE	CA	94087	1969	43	06085	37.36899556	-122.0358929	Santa Clara County
193897	Fee-for-Service	1073971321	1073971321	1	1	JACKIE BAU	6/5/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 SW 10TH ST	None	MADISON	SD	57042	3200	00	None	43.99302789	-97.11819925	Lake County
193918	Fee-for-Service	1558880260	1558880260	1	1	JACOB JOSEPH AND JABEZ FAMIL	10/11/2019	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COUNSELING AND PROFESS	275 W HOSPITALITY LN	325	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
193944	Fee-for-Service	1538185368	1538185368	1	1	JUDD, PATRICIA PHD	11/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193989	Fee-for-Service	1235319062	1235319062	1	1	JUBILEE HOME HEALTH CARE INC	1/30/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1720 E LOS ANGELES AVE	#223	ENCINO	CA	93065	2008	56	06111	34.2716455	-118.7653635	Ventura County
194037	Fee-for-Service	1487623575	1487623575	1	1	JACOBY, ROBYN DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7474	None	None	0	In state provider	None	430 W BASELINE RD	None	CLAREMONT	CA	91711	1607	19	06037	34.12157453	-117.7214355	Los Angeles County
194115	Fee-for-Service	1912124686	1912124686	2	1	JOHNSON, KRISTIE LMFT	8/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 VERNON ST	B	ROSEVILLE	CA	95678	2600	31	06061	38.74793156	-121.2853565	Placer County
194171	Fee-for-Service	1003830316	1003830316	1	1	JOHNSON, MALCOLM C MD	5/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94962	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
194193	Fee-for-Service	1053465385	1053465385	1	1	JOHNSON, KENNISHA A LMFT	11/20/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43943	-	NOT APPLICABLE	0	In state provider	None	1420 WILLOW PASS ROAD	STE 140	CONCORD	CA	94520	5823	07	06013	37.96956948	-122.0507563	Contra Costa County
194409	Fee-for-Service	1245786532	1245786532	1	1	JWCH INSTITUTE, INC	3/28/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	10750 LAUREL AVE	None	WHITTIER	CA	90605	3282	19	06037	33.935508	-118.0487745	Los Angeles County
194483	Fee-for-Service	1386039188	1386039188	1	1	JANOWSKY, MARIEL L MD MPH	1/14/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	147176	-	NOT APPLICABLE	0	In state provider	None	3594 FOURTH AVE	None	SAN DIEGO	CA	92103	4940	37	06073	32.74318084	-117.1615865	San Diego County
194497	Fee-for-Service	1497029078	1497029078	1	1	JAIN, RITU MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125466	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
194550	Fee-for-Service	1689284309	1689284309	1	1	JASMIN SIDHU, MD INC	11/23/2020	207R00000X	NA	Other	026	PHYSICIANS	None	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
194583	Fee-for-Service	1821298290	1821298290	1	1	JONES, MICHAEL E 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
194585	Fee-for-Service	1770893554	1770893554	1	1	JONES, KEVIN M DO	10/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
194644	Fee-for-Service	1356541502	1356541502	1	1	JEYAKUMAR, DEEPA MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121651	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
194649	Fee-for-Service	1114930492	1114930492	1	1	JOHNS, TIMOTHY 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	8487	00	None	33.31386	-111.6877185	Maricopa County
194699	Fee-for-Service	1245786532	1245786532	1	1	JWCH INSTITUTE, INC	3/28/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	10750 LAUREL AVE	None	WHITTIER	CA	90605	3282	19	06037	33.935508	-118.0487745	Los Angeles County
194877	Fee-for-Service	1972648913	1972648913	1	1	JEFFREY R DINGMAN, 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	0000	00	None	43.55346193	-116.5727785	Canyon County
194919	Fee-for-Service	1659399327	1659399327	1	1	JUNQUEIRA, HELOISA S MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56413	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
194938	Fee-for-Service	1356541502	1356541502	1	1	JEYAKUMAR, DEEPA MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121651	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195095	Fee-for-Service	1780264267	1780264267	1	1	JEON, SEONMI NP	6/2/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1300 N VERMONT AVE	1001	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
195100	Fee-for-Service	1720128309	1720128309	1	1	JONBEC CARE, INC	1/15/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1930 GOULD ST	None	LOMA LINDA	CA	92354	1743	36	06071	34.07082573	-117.2457859	San Bernardino County
195153	Fee-for-Service	1689656605	1689656605	1	1	JUMRUSSIRIKUL, PITAYADET 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 6TH AVE	None	DES MOINES	IA	50314	2613	00	None	41.598765	-93.623175	Polk County
195167	Fee-for-Service	1831138106	1831138106	1	1	JOHNSON, CHARLES S MD	7/30/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	56688	84	Surgery-Head and Neck	0	In state provider	None	645 W HARDING WAY	STE 5	STOCKTON	CA	95204	5688	39	06077	37.96586464	-121.3036751	San Joaquin County
195222	Fee-for-Service	1356541502	1356541502	1	1	JEYAKUMAR, DEEPA MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121651	68	Hematology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195251	Fee-for-Service	1114971736	1114971736	1	1	JOSHI, MANDAR V MD	6/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	91757	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
195352	Fee-for-Service	1902977762	1902977762	1	1	JONES, JAMIESON E MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41922	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
195375	Fee-for-Service	1063854990	1063854990	1	1	JULIAN, BAO-QUYNH T MD	9/15/2022	208200000X	NA	General Surgery	026	PHYSICIANS	132663	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
195475	Fee-for-Service	1215017132	1215017132	1	1	JOHN V OLSEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SWEDISH HEART & VASCULAR	550 17TH AVE 6TH FLOOR	None	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
195532	Fee-for-Service	1821207028	1821207028	1	1	JONES, DEAN T LCSW	6/15/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
195541	Fee-for-Service	1447335252	1447335252	1	1	JINGUJI,THOMAS 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	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
195703	Fee-for-Service	1427078658	1427078658	1	1	JACOBS, PATRICIA W MD	3/31/1990	207R00000X	NA	Other	026	PHYSICIANS	68386	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA #365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
195720	Fee-for-Service	1639107394	1639107394	1	1	JASON MIZELL	3/4/2024	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
195778	Fee-for-Service	1033179841	1033179841	1	1	JEFFREY ROSS M.D.	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 WALTER ST NE	STE 104	ALBUQUERQUE	NM	87102	2541	00	None	35.08716551	-106.6401923	Bernalillo County
195835	Fee-for-Service	1265609341	1265609341	1	1	JAMES, LAURIE A DO	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11236	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
195887	Fee-for-Service	1669945705	1669945705	1	1	JAMES, ANDREA D CNM	9/6/2022	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
195919	Fee-for-Service	1841876794	1841876794	1	1	JAIN, CHANDNI	9/9/2024	390200000X	NA	Other	026	PHYSICIANS	192411	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
195952	Fee-for-Service	1205899929	1205899929	1	1	JIN, JUNG Y NP	3/22/2022	363LA2200X	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
195966	Fee-for-Service	1407800980	1407800980	1	1	JUDY MESSER M.D.	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
196131	Fee-for-Service	1811061237	1811061237	1	1	JASMER, ELLEN L	12/1/2000	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16563 DRAPER MINE RD	None	SONORA	CA	95370	8411	55	06109	37.9846745	-120.2799085	Tuolumne County
196219	Fee-for-Service	1508953837	1508953837	1	1	JUN HOUNG & HAE JIN LEE	10/23/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	966 S WESTERN AVENUE	SUITE 201	LOS ANGELES	CA	90006	1015	19	06037	34.053777	-118.3090505	Los Angeles County
196237	Fee-for-Service	1093126609	1093126609	1	1	JAIRAM, COLIN X MD INC	4/17/2015	207P00000X	NA	Other	026	PHYSICIANS	101534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1031 AVENIDA PICO	STE 103	SAN CLEMENTE	CA	92673	6355	30	06059	33.45715546	-117.5990722	Orange County
196238	Fee-for-Service	1659876381	1659876381	1	1	JAFARPOUR, SABA MD	7/18/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	175166	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
196257	Fee-for-Service	1437325404	1437325404	1	1	JAYATILAKA, MATTHEW G MD	1/1/1979	173000000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1045 S ATLANTIC AVE	STE 818	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
196283	Fee-for-Service	1821635376	1821635376	1	1	JANETS ENTERPRISE INC	8/18/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11451 ACACIA ST	None	LOMA LINDA	CA	92354	3502	36	06071	34.04570252	-117.2580026	San Bernardino County
196332	Fee-for-Service	1699964031	1699964031	1	1	JESSER, JAMYE J PSYD	7/22/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	225 CIVIC DR	SUITE 2-11	PALM SPRINGS	CA	92262	7226	33	06065	33.82172907	-116.5127475	Riverside County
196344	Fee-for-Service	1851726897	1851726897	1	1	JOYNER, KRISTEN N PHD	11/9/2016	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
196359	Fee-for-Service	1548588890	1548588890	1	1	JOHNSON, KNUTE A PHD	3/12/2021	251S00000X	NA	Other	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
196361	Fee-for-Service	1306339759	1306339759	1	1	JEFFREY DEMIAN INC	4/5/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3609 NEWTON ST	None	TORRANCE	CA	90503	2148	19	06037	33.7992104	-118.3481455	Los Angeles County
196402	Fee-for-Service	1427057132	1427057132	1	2	JENKINSON, ERIC J MD	1/6/2016	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	3499 HIATT DR	None	REDDING	CA	96003	1204	45	06089	40.63099955	-122.402529	Shasta County
196525	Fee-for-Service	1093126609	1093126609	1	1	JAIRAM, COLIN X MD INC	4/17/2015	207P00000X	NA	Other	026	PHYSICIANS	101534	01	General Practice	0	In state provider	None	1031 AVENIDA PICO	STE 103	SAN CLEMENTE	CA	92673	6355	30	06059	33.45715546	-117.5990722	Orange County
196553	Fee-for-Service	1649053026	1649053026	1	1	JAMBUSARIA, SAGAR PT	2/28/2025	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
196579	Fee-for-Service	1750538575	1750538575	1	1	JEREMIAH FLEENOR	11/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 KOENIGSTEIN AVE	None	NORFOLK	NE	68701	3664	00	None	42.03388191	-97.43100885	Madison County
196676	Fee-for-Service	1871209924	1871209924	1	1	JAEGER-KRAUSE, MARIE N MD	7/9/2024	2080P0207X	NA	Hematology	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
196738	Fee-for-Service	1659525111	1659525111	1	1	JORGENSEN, DONNA E	1/16/2009	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	740 LOMAS SANTA FE DRIVE	STE 110	SOLANA BEACH	CA	92075	1441	37	06073	32.9960581	-117.2579748	San Diego County
196828	Fee-for-Service	1366080459	1366080459	1	1	JANETS ENTERPRISE INC	7/9/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7380 CARTILLA AVE	None	RANCHO CUCAMONGA	CA	91730	1706	36	06071	34.12006924	-117.5787138	San Bernardino County
196834	Fee-for-Service	1164944666	1164944666	1	1	JOHNSTONE, TEVA LCSW	2/1/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5550 TELEGRAPH RD	C3	VENTURA	CA	93003	4254	56	06111	34.27717324	-119.2199411	Ventura County
196935	Fee-for-Service	1073596821	1073596821	1	1	JANSSEN, LUIS A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1212 COLLEGE AVE	STE B	SANTA ROSA	CA	95404	3908	49	06097	38.445138	-122.706846	Sonoma County
196971	Fee-for-Service	1871694067	1871694067	1	1	JAIME DELCAMPO, 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	1901 S UNION AVE	None	TACOMA	WA	98405	1702	00	None	47.2412305	-122.4823303	Pierce County
197036	Fee-for-Service	1780973412	1780973412	1	1	JOO, MICHAEL S MD	3/20/2023	207P00000X	NA	Other	026	PHYSICIANS	167709	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
197075	Fee-for-Service	1215320130	1215320130	1	1	JELMINI, STEVEN M PT	1/31/2019	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
197095	Fee-for-Service	1295892040	1295892040	1	1	JUNG, BARBARA L OPT	5/1/1990	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1080 S WHITE RD	STE A	SAN JOSE	CA	95127	3821	43	06085	37.35796288	-121.8207543	Santa Clara County
197102	Fee-for-Service	1962551861	1962551861	1	1	JOHN MUIR TRAUMA PHYS	7/1/1987	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP - PSYCHIATRY	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
197136	Fee-for-Service	1447738455	1447738455	1	1	JAVAHERIAN, HANRIET H RCP	10/17/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
197159	Fee-for-Service	1578227161	1578227161	1	1	JOSE GUERRA, PSYCHOLOGIST PC	6/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ICES	9010 CORBIN AVENUE	SUITE 4B	NORTHRIDGE	CA	91324	3344	19	06037	34.23447488	-118.5622843	Los Angeles County
197226	Fee-for-Service	1841378668	1841378668	1	1	JHUTTI,MANDEEP K DO	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8841	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
197405	Fee-for-Service	1710900352	1710900352	1	1	JUSTUS, MARK S . MD	12/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD STREET	None	RENTON	WA	98055	0000	00	None	47.44115887	-122.2138846	King County
197406	Fee-for-Service	1134277437	1134277437	1	1	JENSEN, REBECCA N	3/30/1991	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1057 11TH ST	None	LAKEPORT	CA	95453	4105	17	06033	39.0489894	-122.9248409	Lake County
197455	Fee-for-Service	1083632467	1083632467	1	1	JACKSON, KELLY G CCC-SLP	3/24/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
197460	Fee-for-Service	1134176555	1134176555	1	1	JUDE, CHRISTINE L C CNM	6/5/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
197536	Fee-for-Service	1063454122	1063454122	1	1	JOHN A JACKSON, M.D.	8/29/2011	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
197561	Fee-for-Service	1104102250	1104102250	1	1	JAURIGUI, KELLEY K LCSW	10/18/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
197611	Fee-for-Service	1407982622	1407982622	1	1	JONES, AMY E MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90693	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
197633	Fee-for-Service	1134202849	1134202849	2	1	JESSANI, PARVEZ P MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131631	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
197648	Fee-for-Service	1447291034	1447291034	1	1	JYOTSNA,RAVI J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
197685	Fee-for-Service	1548322688	1548322688	1	1	JONES, KATHLEEN K MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	37766	04	Otology, Laryngology, Rhinology	0	In state provider	None	18092 WIKA RD	STE 120	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
197731	Fee-for-Service	1962607911	1962607911	1	1	JOHNSON, MICHAEL 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	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
197744	Fee-for-Service	1366428971	1366428971	1	1	JOHN A WERRING MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	651 WILLOW GROVE ST	None	HACKETTSTOWN	NJ	07840	1799	00	None	40.86094042	-74.81460371	Warren County
197755	Fee-for-Service	1124041520	1124041520	1	2	JO TAYLOR MD INC	1/1/1990	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
197765	Fee-for-Service	1033426341	1033426341	1	1	JAISWAL, BHAVINI J MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100525	None	None	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
197810	Fee-for-Service	1629729322	1629729322	1	1	JEUNG, SAMANTHA OT	11/3/2023	225X00000X	NA	Other	019	OCCUPATIONAL 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
197826	Fee-for-Service	1114208931	1114208931	1	1	JUHN, EDWARD T MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111730	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197939	Fee-for-Service	1689752586	1689752586	1	1	JIANG, LIN MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78538	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
197976	Fee-for-Service	1548322688	1548322688	1	1	JONES, KATHLEEN K MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	37766	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	18092 WIKA RD	STE 120	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
197982	Fee-for-Service	1144396292	1144396292	1	1	JONES, ERIN E C LCSW	11/6/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	61727	-	NOT APPLICABLE	0	In state provider	None	102 S 11TH STREET	None	SAN JOSE	CA	95112	2132	43	06085	37.33916461	-121.8784624	Santa Clara County
198006	Fee-for-Service	1912468455	1912468455	1	1	JOHNS, CLAIRE E MD	5/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177634	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
198019	Fee-for-Service	1932143583	1932143583	1	1	JONATHAN WOOD 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	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
198141	Fee-for-Service	1548211758	1548211758	1	1	JJ&R EMERGENCY MED GROUP	12/14/1992	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA INC	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
198190	Fee-for-Service	1336191063	1336191063	1	1	JOHNSON, CRAIG MD	1/26/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72241	01	General Practice	0	In state provider	None	950 CIRCLE DR	None	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
198322	Fee-for-Service	1447228259	1447228259	1	1	JAFFER, SAEED N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74086	07	Dermatology	0	In state provider	BOSTON MEDICAL AND SURGI	247 W SAN BERNARDINO RD	None	COVINA	CA	91723	1516	19	06037	34.08997675	-117.8937437	Los Angeles County
198331	Fee-for-Service	1609396555	1609396555	1	1	JEBBIA, MALLORY MD	7/29/2023	390200000X	NA	Other	026	PHYSICIANS	157063	None	None	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198403	Fee-for-Service	1407419070	1407419070	1	1	JIAO, JOHN MD	6/7/2022	390200000X	NA	Other	026	PHYSICIANS	177043	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
198424	Fee-for-Service	1285345553	1285345553	1	1	JENKINS, ELIZABETH A LCSW	9/25/2023	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
198589	Fee-for-Service	1548233141	1548233141	1	1	JOHN BOCCIA	3/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
198616	Fee-for-Service	1326347576	1326347576	1	1	JAMES, SCOTT E MD	5/31/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
198622	Fee-for-Service	1366133985	1366133985	1	1	JUAREZ, FERNANDO	6/5/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2360 S AZUSA AVE	A3	WEST COVINA	CA	91792	1539	19	06037	34.03422947	-117.9131031	Los Angeles County
198803	Fee-for-Service	1144664624	1144664624	1	1	JUSTISS, ABIGAIL A MD	12/16/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180250	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
198813	Fee-for-Service	1881684900	1881684900	1	1	JACOB HEALTH CARE CENTER LP	7/9/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4075 54TH ST	None	SAN DIEGO	CA	92105	2301	37	06073	32.750442	-117.0794645	San Diego County
198848	Fee-for-Service	1194041996	1194041996	1	1	JOYCE, EMILY D MD	7/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156194	30	Radiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
198905	Fee-for-Service	1326347576	1326347576	1	1	JAMES, SCOTT E MD	5/31/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
198943	Fee-for-Service	1205892304	1205892304	1	1	JOE, PRISCILLA MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60802	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
199010	Fee-for-Service	1306340096	1306340096	1	1	JONES, TANIA M BIRTH DOULA	4/5/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	28	06055	0	0	None
199048	Fee-for-Service	1912938184	1912938184	1	2	JIANG, YING MD	6/1/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7200 PARKWAY DR	STE 116	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
199061	Fee-for-Service	1912323965	1912323965	1	1	JONES, STEVEN T	4/13/2015	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
199128	Fee-for-Service	1730162892	1730162892	1	1	JOHNSON, MILLARD E MD	8/13/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62787	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
199137	Fee-for-Service	1619337250	1619337250	1	1	JORDAN, CYNTHIA	1/29/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10635 SUNNYMEAD CREST LN	None	MORENO VALLEY	CA	92557	4233	33	06065	33.965865	-117.228303	Riverside County
199178	Fee-for-Service	1073709580	1073709580	1	1	JIMENEZ, ERICA LMFT	4/19/2021	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
199192	Fee-for-Service	1679772867	1679772867	2	1	J TREES RITTER, D.O. INC.	5/27/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EASES CONSULTANTS	1551 BISHOP ST	250	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
199202	Fee-for-Service	1700997749	1700997749	1	1	JAMES, PAUL G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30002	20	Orthopedic Surgery	0	In state provider	None	993 CASS ST	None	MONTEREY	CA	93940	4517	27	06053	36.59238008	-121.8963872	Monterey County
199239	Fee-for-Service	1497861439	1497861439	1	1	JAVAHERI, SHAHRAM MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	64239	10	Gastroenterology (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
199274	Fee-for-Service	1316984206	1316984206	1	1	JOSEPH STAPCZYNSKI MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	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
199374	Fee-for-Service	1275853434	1275853434	1	1	JAMSHIDI, NEEMA MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118913	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
199423	Fee-for-Service	1265633150	1265633150	1	1	JACOBS, SHELLEY J CNM	10/28/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	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
199424	Fee-for-Service	1619337250	1619337250	1	1	JORDAN, CYNTHIA	1/29/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10635 SUNNYMEAD CREST LN	None	MORENO VALLEY	CA	92557	4233	33	06065	33.965865	-117.228303	Riverside County
199427	Fee-for-Service	1295236388	1295236388	1	1	JOHNSON, CRAIG M CRNA	5/24/2022	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
199434	Fee-for-Service	1982701355	1982701355	1	1	JONG, LAURA T MD	1/24/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82124	13	Neurology (M.D. only)	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
199503	Fee-for-Service	1033178231	1033178231	1	1	JESS A MILLER	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
199591	Fee-for-Service	1770838062	1770838062	1	1	JAUREGUI, ELIZABETH LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
199615	Fee-for-Service	1750313243	1750313243	1	1	JOHN S MILNE M.D.	10/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	751 NE BLAKELY DR	None	ISSAQUAH	WA	98029	8940	00	None	47.53652154	-122.0220045	King County
199636	Fee-for-Service	1760440267	1760440267	1	1	JANNE D'OTHEE, BERTRAND MD	3/21/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53060	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
199887	Fee-for-Service	1376756031	1376756031	1	1	JACOBSON, CHRISTINE C MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92376	07	Dermatology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
199990	Fee-for-Service	1972252880	1972252880	1	1	JULIE L. ROSS, LICENSED MARR	1/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	IAGE AND FAMILY THERAPIS	650 HAMPSHIRE RD	SUITE 200	WESTLAKE VILLAGE	CA	91361	2540	56	06111	34.15918414	-118.8359242	Ventura County
200007	Fee-for-Service	1629289533	1629289533	1	1	JAMES, ANGELA M LMFT	8/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 155	RANCHO CUCAMONGA	CA	91730	3849	36	06071	34.10227306	-117.5715643	San Bernardino County
200075	Fee-for-Service	1700059672	1700059672	1	1	JACKSON, JOAN LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
200148	Fee-for-Service	1780302711	1780302711	1	1	JOHNSON, KARRYLEE M NP	9/17/2024	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
200153	Fee-for-Service	1508988346	1508988346	1	1	JENSEN,TERESA GAIL MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67192	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
200173	Fee-for-Service	1457024473	1457024473	1	2	JORDAN MEDICAL TRANSPORTATIO	3/17/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	NS INC	3610 CENTRAL AVE	STE 400	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
200315	Fee-for-Service	1457528879	1457528879	1	1	JOURNAGIN, ANDREA M MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139892	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3014	37	06073	32.781195	-117.0070695	San Diego County
200541	Fee-for-Service	1407057573	1407057573	1	1	JIN, LEE-WAY MD	6/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55483	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
200553	Fee-for-Service	1598138224	1598138224	1	1	JURGENS, TRAVIS D PT	10/23/2020	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
200554	Fee-for-Service	1730266057	1730266057	1	1	JONES, KATHLEEN S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38059	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
200588	Fee-for-Service	1245228055	1245228055	1	1	JAMES BRUTON	3/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
200760	Fee-for-Service	1134460603	1134460603	1	1	JAMES, MELODY CNP	2/25/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
200781	Fee-for-Service	1366516197	1366516197	1	1	JOHNSRUD, JEFFREY M MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	51096	02	General Surgery	0	In state provider	None	17542 E 17TH STREET	SUITE 410	TUSTIN	CA	92780	1959	30	06059	33.75966953	-117.8261065	Orange County
200860	Fee-for-Service	1518015304	1518015304	1	1	JESTE, SONALI D MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46629	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
200886	Fee-for-Service	1265764955	1265764955	1	2	JANET S. KIM, M.D. CORP	5/25/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	None	None	0	In state provider	None	300 S HOBART BLVD	300	LOS ANGELES	CA	90020	3635	19	06037	34.0687961	-118.3053621	Los Angeles County
200961	Fee-for-Service	1013967801	1013967801	1	1	JON R ROBISON M.D.	3/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 E 1400 N	None	LOGAN	UT	84341	2406	00	None	41.75742385	-111.8209142	Cache County
201039	Fee-for-Service	1497065080	1497065080	1	1	JONES, KRISTIN DO	11/23/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16867	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
201067	Fee-for-Service	1659803328	1659803328	1	1	JOHNSON, STEVEN E DO	7/11/2023	207L00000X	NA	Other	026	PHYSICIANS	19348	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
201146	Fee-for-Service	1518015304	1518015304	1	1	JESTE, SONALI D MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46629	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
201157	Fee-for-Service	1124019203	1124019203	1	1	JENKINS, RUTH A NP	12/21/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	07	06013	37.90582392	-122.0613697	Contra Costa County
201233	Fee-for-Service	1629179536	1629179536	1	1	JASON, MARK MD	1/31/1982	193400000X	NA	Other	026	PHYSICIANS	37528	83	Rheumatology	0	In state provider	None	25411 CABOT RD	STE 112	LAGUNA HILLS	CA	92653	5517	30	06059	33.59224599	-117.6746001	Orange County
201303	Fee-for-Service	1396270112	1396270112	1	1	JAMASIAN MOBARAKEH, BABAK M	12/22/2020	207R00000X	NA	Other	026	PHYSICIANS	170030	None	None	0	In state provider	D	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
201312	Fee-for-Service	1871248799	1871248799	1	1	JONES, ANESHA L CRNA	4/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
201328	Fee-for-Service	1982963435	1982963435	1	1	JUAREZ, GRACE M MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123110	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
201476	Fee-for-Service	1245327089	1245327089	1	1	JOSE M BARRIOS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9224 TEDDY LN	STE 200	LONETREE	CO	80124	6799	00	None	39.55157784	-104.8813895	Douglas County
201663	Fee-for-Service	1285638031	1285638031	1	1	JORDANIDES, DENNIS T MD	6/1/2000	207R00000X	NA	Other	026	PHYSICIANS	66293	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
201699	Fee-for-Service	1184810707	1184810707	1	1	JUNG, JAE H MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91012	25	Physical Medicine and Rehabilitation	0	In state provider	None	819 AUTO CENTER DRIVE	None	PALMDALE	CA	93551	4599	19	06037	34.59142164	-118.14665	Los Angeles County
201700	Fee-for-Service	1386354819	1386354819	1	1	JUMA, LILIAN ATIENO	1/12/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8825 M.D. BUSH DRIVE	None	ELK GROVE	CA	95758	1338	34	06067	38.436948	-121.4129745	Sacramento County
201704	Fee-for-Service	1427052802	1427052802	1	1	JOHNSTON, WARREN D MD	9/30/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	33255	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
201706	Fee-for-Service	1942268263	1942268263	1	1	JULIE GIBSON CHAMPINE, MD	5/17/2011	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
201711	Fee-for-Service	1811972433	1811972433	1	1	JEWISH FAMILY & CHILDREN SER	7/3/2019	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ERVICE OF LONG BEACH & W	3801 E WILLOW ST	None	LONG BEACH	CA	90815	1734	19	06037	33.80441145	-118.1487752	Los Angeles County
201798	Fee-for-Service	1790186708	1790186708	1	1	JENNINGS, CHARLES A NP	7/15/2016	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
201801	Fee-for-Service	1154067775	1154067775	1	1	JOHAL, NAVEET NP	5/17/2022	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
201814	Fee-for-Service	1538180278	1538180278	1	1	JANSEN, BRUCE 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	1266 LIBERTY ST	None	FRANKLIN	PA	16323	1322	00	None	41.39786082	-79.8305346	Venango County
201865	Fee-for-Service	1912091067	1912091067	1	1	JUAREZ-URIBE, JOEL MD	7/19/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40571	41	Internal Medicine	0	In state provider	None	750 MEDICAL CENTER CT	STE 14	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
201941	Fee-for-Service	1609960228	1609960228	1	1	JOCELYN PARK	12/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
201988	Fee-for-Service	1386354819	1386354819	1	1	JUMA, LILIAN ATIENO	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	8825 M.D. BUSH DRIVE	None	ELK GROVE	CA	95758	1338	34	06067	38.436948	-121.4129745	Sacramento County
202010	Fee-for-Service	1669764676	1669764676	1	1	JARROD HAMPTON	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
202024	Fee-for-Service	1811067804	1811067804	1	1	JENNIFER B CONN, M.D.	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
202027	Fee-for-Service	1154639433	1154639433	1	1	JULIA TUGORES, KILSIS LCSW	4/2/2025	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
202048	Fee-for-Service	1659427680	1659427680	1	1	JULIA WILLIAMS MD	8/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
202114	Fee-for-Service	1003878448	1003878448	1	1	JOHNSON, KEVIN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MEDICAL CENTER OF AURORA	1501 S POTOMAC	None	AURORA	CO	80012	0000	00	None	39.689343	-104.832198	Arapahoe County
202156	Fee-for-Service	1982782637	1982782637	1	1	JOLLY, KENT W MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58699	40	Pediatrics	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
202157	Fee-for-Service	1912091067	1912091067	1	1	JUAREZ-URIBE, JOEL MD	7/19/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	750 MEDICAL CENTER CT	STE 14	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
202166	Fee-for-Service	1609001965	1609001965	1	1	JOTWANI, RAKESH P MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107761	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
202204	Fee-for-Service	1699964908	1699964908	1	1	JACKSON, JOY M MD	4/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97372	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
202287	Fee-for-Service	1235770165	1235770165	1	2	JOHNSON, P. CURLY CNP	8/28/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	508315	-	NOT APPLICABLE	0	In state provider	None	1839 S EL DORADO STREET	None	STOCKTON	CA	95206	2025	39	06077	37.93316949	-121.2845192	San Joaquin County
202296	Fee-for-Service	1619208279	1619208279	1	1	JACOUB, JACK F MD INC	6/1/2011	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	18111 BROOKHURST STREET	STE 6100 & 6150	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
202314	Fee-for-Service	1023359494	1023359494	1	1	JESWANI, SUNIL P	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107760	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
202338	Fee-for-Service	1033439492	1033439492	1	1	JOHNSON, DUSTIN MD	7/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170468	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
202363	Fee-for-Service	1346474574	1346474574	1	1	JUNG, MINCHUL PT	9/18/2018	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
202441	Fee-for-Service	1912091067	1912091067	1	1	JUAREZ-URIBE, JOEL MD	7/19/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40571	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	750 MEDICAL CENTER CT	STE 14	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
202443	Fee-for-Service	1982782637	1982782637	1	1	JOLLY, KENT W MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58699	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
202456	Fee-for-Service	1598815938	1598815938	1	1	JACKSON, HELEN M MD	5/31/1995	207P00000X	NA	Other	026	PHYSICIANS	81898	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
202464	Fee-for-Service	1598206740	1598206740	1	1	JAMIL, ASMA MD	8/24/2020	390200000X	NA	Other	026	PHYSICIANS	164106	41	Internal Medicine	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
202473	Fee-for-Service	1629574744	1629574744	1	1	JO, LINDA DO	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	17878	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
202495	Fee-for-Service	1699964908	1699964908	1	1	JACKSON, JOY M MD	4/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97372	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
202551	Fee-for-Service	1720016710	1720016710	1	1	JASON E COX M.D.	12/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2240 SUTHERLAND AVE	STE 104	KNOXVILLE	TN	37919	2333	00	None	35.95707787	-83.95193291	Knox County
202553	Fee-for-Service	1154488765	1154488765	1	1	JOSIAH-DAVIS, ERNA I NP	4/4/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
202584	Fee-for-Service	1619208279	1619208279	1	1	JACOUB, JACK F MD INC	6/1/2011	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	18111 BROOKHURST STREET	STE 6100 & 6150	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
202690	Fee-for-Service	1366440620	1366440620	1	1	JORDAN VLY MED CTR LP	7/1/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3460 PIONEER PKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
202697	Fee-for-Service	1295716652	1295716652	1	1	JON P FILARDI MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 MEDICAL PKWY	STE 570	AUSTIN	TX	78705	1024	00	None	30.30500791	-97.74430984	Travis County
202891	Fee-for-Service	1548321862	1548321862	1	1	JACKSON,JOHN 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	95 EAST CENTER	PO BOX 669	GUNNISON	UT	84634	0000	00	None	39.15518964	-111.8153552	Sanpete County
202967	Fee-for-Service	1770542987	1770542987	1	1	JORIS, LIESBET MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54069	47	Miscellaneous	0	In state provider	None	10666 N TORREY PINES RD	STE MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
202969	Fee-for-Service	1093097818	1093097818	1	1	JONES, LEELA A	7/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11943	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
202978	Fee-for-Service	1366440620	1366440620	1	1	JORDAN VLY MED CTR LP	7/1/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3460 PIONEER PKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
203012	Fee-for-Service	1235797556	1235797556	1	1	JIMENEZ, JOSEPHINE	11/21/2023	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
203099	Fee-for-Service	1982882916	1982882916	1	1	JMS MEDICAL SUPPLY LLC	9/24/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	JMS MEDICAL SUPPLY LLC	1190 MIRALOMA WAY	STE X	SUNNYVALE	CA	94085	4607	43	06085	37.37883455	-121.9968135	Santa Clara County
203171	Fee-for-Service	1801139175	1801139175	1	2	JACOB, GABRIEL MD A MEDICAL	7/2/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CORPORATION	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
203258	Fee-for-Service	1134895543	1134895543	1	1	JW2 LLC	4/25/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	922 E BRIGHAM ROAD	4D	SAINT GEORGE	UT	84790	8750	00	None	37.05338015	-113.5644562	Washington County
203270	Fee-for-Service	1033537816	1033537816	1	1	JOONIANI, IRANDOKHT M MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
203329	Fee-for-Service	1164466652	1164466652	1	1	JAHR, JONATHAN S MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	63181	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
203459	Fee-for-Service	1801139175	1801139175	1	2	JACOB, GABRIEL MD A MEDICAL	7/2/2013	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
203535	Fee-for-Service	1669676524	1669676524	1	2	JACOBS, KARL	9/21/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	79582	36	Psychiatry	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
203611	Fee-for-Service	1588923510	1588923510	1	1	JIN, JAMES C CRNA	12/24/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVENUE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
203629	Fee-for-Service	1467872143	1467872143	1	1	JEFFREY RODRIGUEZ	3/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
203878	Fee-for-Service	1982144135	1982144135	1	1	JEONG, HYEJIN CNP	12/6/2018	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
203885	Fee-for-Service	1487892212	1487892212	1	1	JOURDAIN, VICTOR J MD	3/18/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	105907	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
203903	Fee-for-Service	1184695785	1184695785	1	1	JOURDANTON HOSPITAL	2/11/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	1905 HIGHWAY 97 E	None	JOURDANTON	TX	78026	1504	00	None	28.93222631	-98.52479482	Atascosa County
204000	Fee-for-Service	1083034037	1083034037	1	1	JIN, LAN MD	8/7/2020	207R00000X	NA	Other	026	PHYSICIANS	143052	41	Internal Medicine	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
204098	Fee-for-Service	1174043129	1174043129	1	1	JAVIDAN UROLOGY INC	1/10/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	6600 COYLE AVE	UNIT 1	CARMICHAEL	CA	95608	6344	34	06067	38.667807	-121.310748	Sacramento County
204118	Fee-for-Service	1902268667	1902268667	1	1	JAKUBOWSKI, BRANDON R MD	5/25/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	178338	None	None	0	In state provider	None	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
204121	Fee-for-Service	1942869615	1942869615	1	1	JUN, CHARLES H DO	8/23/2023	207L00000X	NA	Other	026	PHYSICIANS	20758	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
204190	Fee-for-Service	1184695785	1184695785	1	1	JOURDANTON HOSPITAL	2/11/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	1905 HIGHWAY 97 E	None	JOURDANTON	TX	78026	1504	00	None	28.93222631	-98.52479482	Atascosa County
204212	Fee-for-Service	1063510840	1063510840	1	1	JOSEPHSON, DAVID Y MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75701	34	Urology and Urological Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
204257	Fee-for-Service	1750079034	1750079034	1	1	JAVIER, IRINEO ABELLON	6/14/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1031 CARLISLE CT	None	VACAVILLE	CA	95688	8868	48	06095	38.40120866	-121.9452995	Solano County
204342	Fee-for-Service	1376913319	1376913319	1	1	JO, HEATHER J NP	6/13/2024	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
204351	Fee-for-Service	1588863823	1588863823	1	1	JESTE, SHAFALI S MD	8/25/2010	2084N0402X	NA	Neurology	026	PHYSICIANS	111808	79	Neurology-Child	0	In state provider	None	760 WESTWOOD PLAZA	RM 68277 B	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
204380	Fee-for-Service	1588802029	1588802029	1	1	JOHNSON, NICOLE L LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204407	Fee-for-Service	1073952412	1073952412	1	1	JERANKO, CHELSEA DO	7/16/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19212	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
204443	Fee-for-Service	1508895699	1508895699	1	1	JAFFURS, DANIEL C MD	8/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104687	24	Plastic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
204544	Fee-for-Service	1750079034	1750079034	1	1	JAVIER, IRINEO ABELLON	6/14/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1031 CARLISLE CT	None	VACAVILLE	CA	95688	8868	48	06095	38.40120866	-121.9452995	Solano County
204577	Fee-for-Service	1396064473	1396064473	1	1	JIAM-SEAGREN, CATHERINE MD	8/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123805	08	Family Practice	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
204617	Fee-for-Service	1306161948	1306161948	1	1	JALALI, SARA MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149076	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
204642	Fee-for-Service	1578124871	1578124871	1	1	JAVIER JARDON, M.D., MEDICAL	12/15/2019	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	4131 SLAUSON AVE	None	MAYWOOD	CA	90270	2833	19	06037	33.98776668	-118.1912497	Los Angeles County
204682	Fee-for-Service	1730943366	1730943366	1	1	JOOSTEN, ALEXANDRE P MD	10/4/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
204737	Fee-for-Service	1629556337	1629556337	1	1	JOU, JONATHAN MD	5/14/2024	204F00000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
205015	Fee-for-Service	1275897407	1275897407	1	1	JAIN, NICKUL S MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127523	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
205072	Fee-for-Service	1609836972	1609836972	1	1	JAVAHERIAN, VAHID MD	11/1/1992	207R00000X	NA	Other	026	PHYSICIANS	6352	09	Gynecology (D.O. only)	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
205098	Fee-for-Service	1194827980	1194827980	2	1	JOHNSTON, JERRILYN MD	12/29/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	67392	40	Pediatrics	0	In state provider	None	20101 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
205135	Fee-for-Service	1508836917	1508836917	1	1	J. GLENN HAINES, 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	1830 WELLS ST	STE 101	WAILUKU	HI	96793	2365	00	None	20.88726913	-156.4991069	Maui County
205143	Fee-for-Service	1528009941	1528009941	1	1	JADVAR, HOSSEIN MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	79981	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
205293	Fee-for-Service	1548354087	1548354087	1	1	JACOBS, DON M MD	8/4/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40956	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
205355	Fee-for-Service	1932257821	1932257821	1	1	JEBELLI, BABAK MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68032	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 E HIGHLAND AVE	STE 450	SAN BERNARDINO	CA	92404	3836	36	06071	34.1358627	-117.2757778	San Bernardino County
205430	Fee-for-Service	1528009941	1528009941	1	1	JADVAR, HOSSEIN MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	79981	42	Nuclear Medicine	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
205444	Fee-for-Service	1134576986	1134576986	1	1	JANASWAMY, PRANEETH SRIVATSA	10/15/2020	208M00000X	NA	Other	026	PHYSICIANS	164402	None	None	0	In state provider	MD	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
205456	Fee-for-Service	1134134091	1134134091	1	1	JEWELL, BENJAMIN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79082	08	Family Practice	0	In state provider	None	1001 PROFESSIONAL DR	None	NAPA	CA	94558	6413	28	06055	38.32002271	-122.2937213	Napa County
205506	Fee-for-Service	1134492069	1134492069	1	2	JACKSON, STEVEN	6/27/2024	1041C0700X	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
205542	Fee-for-Service	1497015911	1497015911	1	1	JUUL, NICHOLAS H MD	11/1/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	129692	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
205593	Fee-for-Service	1679692578	1679692578	1	1	JUMAH, ROSE L MD	5/22/2021	207RC0200X	NA	Other	026	PHYSICIANS	60436	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
205615	Fee-for-Service	1831585595	1831585595	1	1	JIANG, YAN MD	7/7/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	144060	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
205658	Fee-for-Service	1801960497	1801960497	1	1	JOSEPH, SUSAN D MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	79794	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
205780	Fee-for-Service	1497382642	1497382642	1	1	JORDAN, OLIVIA J MD	6/29/2023	207R00000X	NA	Other	026	PHYSICIANS	186923	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
205803	Fee-for-Service	1255825378	1255825378	1	1	JENSEN, ADRIANNA D MD	6/9/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	176082	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
205834	Fee-for-Service	1700086667	1700086667	1	1	JACKSON, ROZALIE V MD	4/29/2008	207R00000X	NA	Other	026	PHYSICIANS	95067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1045 ATLANTIC AVE	STE 812	LONG BEACH	CA	90813	3424	19	06037	33.780267	-118.1850795	Los Angeles County
205846	Fee-for-Service	1174284509	1174284509	1	1	JMK MEDICAL CLINIC	5/19/2022	2083C0008X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1050 KENDALL DR	SUITE F	SAN BERNARDINO	CA	92407	4125	36	06071	34.16464044	-117.3063239	San Bernardino County
206008	Fee-for-Service	1467658013	1467658013	1	1	JAMALEDDINE, GHASSAN W MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143676	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
206101	Fee-for-Service	1295848679	1295848679	1	1	JIFFRY, AHAMED J MD	11/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43501	34	Urology and Urological Surgery	0	In state provider	None	399 E HIGHLAND AVE	STE 312	SAN BERNARDINO	CA	92404	3855	36	06071	34.1358627	-117.2757898	San Bernardino County
206121	Fee-for-Service	1811061237	1811061237	1	2	JASMER, ELLEN L	4/26/2024	367A00000X	NA	Certified Nurse Midwife	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
206213	Fee-for-Service	1700576675	1700576675	1	1	JUERGENS, BABETTA DOULA	5/16/2023	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	36	06071	0	0	None
206254	Fee-for-Service	1699909663	1699909663	1	1	JEFFREY THOMAS PEPIN MD	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 RIVERSIDE AVE	None	MINNEAPOLIS	MN	55454	1450	00	None	44.96613258	-93.23756795	Hennepin County
206313	Fee-for-Service	1932366143	1932366143	1	1	JUSTIN JOSEPH REISENAUER MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
206360	Fee-for-Service	1477520526	1477520526	1	1	J.PAUL JONES HOSPITAL	4/26/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MCWILLIAMS AVE	None	CAMDEN	AL	36726	1623	00	None	31.99751367	-87.29944595	Wilcox County
206394	Fee-for-Service	1295848679	1295848679	1	1	JIFFRY, AHAMED J MD	11/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43501	01	General Practice	0	In state provider	None	399 E HIGHLAND AVE	STE 312	SAN BERNARDINO	CA	92404	3855	36	06071	34.1358627	-117.2757898	San Bernardino County
206402	Fee-for-Service	1760707012	1760707012	1	1	JOU, JENNIFER MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132030	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
206682	Fee-for-Service	1295848679	1295848679	1	1	JIFFRY, AHAMED J MD	11/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43501	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 312	SAN BERNARDINO	CA	92404	3855	36	06071	34.1358627	-117.2757898	San Bernardino County
206891	Fee-for-Service	1821227174	1821227174	1	1	JANSEN, MATTI R MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118829	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
206923	Fee-for-Service	1073793949	1073793949	1	1	JIMENEZ, JUSTIN C CRNA	10/20/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
207024	Fee-for-Service	1417309915	1417309915	1	1	JUN, IK	9/15/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153521	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
207105	Fee-for-Service	1053391243	1053391243	1	1	JOHNSON, MICHAEL P MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50420	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
207142	Fee-for-Service	1962791202	1962791202	1	1	JOSHI, DIPIKA B MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137862	18	Ophthalmology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
207202	Fee-for-Service	1780784785	1780784785	1	1	JONES, LORRAINE A MD	12/1/1987	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	38831	40	Pediatrics	0	In state provider	None	111 CONGRESS ST #A	None	PASADENA	CA	91105	0000	19	06037	34.13403798	-118.1534579	Los Angeles County
207212	Fee-for-Service	1477672046	1477672046	1	1	JOHNSON, RONALD M MD	10/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	19831	02	General Surgery	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
207218	Fee-for-Service	1164587689	1164587689	1	1	JEFFREY, ROBERT B MD	7/1/1979	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30905	30	Radiology	0	In state provider	None	3RD AND PARNASSUS AVE M3	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.762974	-122.459769	San Francisco County
207274	Fee-for-Service	1407506058	1407506058	1	1	JEFIC, MITRA DO	6/17/2024	207P00000X	NA	Other	026	PHYSICIANS	21564	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
207278	Fee-for-Service	1841641370	1841641370	1	1	JAYAKUMAR, NAVEEN MD	7/11/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	159018	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
207287	Fee-for-Service	1750644258	1750644258	1	1	JURKOWSKI MEDICAL CORPORATIO	4/4/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	37	06073	32.93714729	-117.0990446	San Diego County
207392	Fee-for-Service	1417055518	1417055518	1	1	JACOBS, KENNETH MD	3/28/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
207451	Fee-for-Service	1679669261	1679669261	2	1	JEFFRY LINDEN BAUM	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	320 ALPENGLOW LN	None	LIVINGSTON	MT	59047	8506	00	None	45.675135	-110.5268085	Park County
207498	Fee-for-Service	1760649362	1760649362	1	1	JOHNSON, TIFFANI J MD	2/12/2020	2080P0204X	NA	Other	026	PHYSICIANS	165284	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
207515	Fee-for-Service	1679630685	1679630685	1	1	JORDAN, KATHLEEN T MD	2/14/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	84721	77	Infectious Disease	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
207574	Fee-for-Service	1750644258	1750644258	1	1	JURKOWSKI MEDICAL CORPORATIO	12/27/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	37	06073	32.93714729	-117.0990446	San Diego County
207650	Fee-for-Service	1235421942	1235421942	1	1	JASON M PATERA MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
207682	Fee-for-Service	1417055518	1417055518	1	1	JACOBS, KENNETH MD	3/28/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
207781	Fee-for-Service	1508914334	1508914334	1	1	JUNG, GREGORY A MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80106	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
207795	Fee-for-Service	1043448996	1043448996	1	1	JOTWANI, VASANTHA K MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110980	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
207803	Fee-for-Service	1679630685	1679630685	1	1	JORDAN, KATHLEEN T MD	2/14/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	84721	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
207846	Fee-for-Service	1093864837	1093864837	1	1	JOHN MUIR TRAUMA PHYS	7/1/1987	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP - OTOLARYGOLOGY	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
207858	Fee-for-Service	1861737876	1861737876	1	1	JOHNSON, PERRI W PSYCHOLOGY	5/4/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	11331 VENTURA BLVD	STE 1D	STUDIO CITY	CA	91604	3147	19	06037	34.14024752	-118.377123	Los Angeles County
207891	Fee-for-Service	1295406593	1295406593	1	1	JASON D. TORANTO, MD INC.	10/7/2021	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	5395 RUFFIN RD	102	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
207900	Fee-for-Service	1184783755	1184783755	1	1	JOSEPH, ABRAHAM MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32846	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
207921	Fee-for-Service	1902913239	1902913239	1	1	JOHNSON, DAVID L MD	12/2/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	54829	-	NOT APPLICABLE	0	In state provider	None	2060 CAMPUS DRIVE	None	YREKA	CA	96097	9538	47	06093	41.7050458	-122.6481121	Siskiyou County
207997	Fee-for-Service	1235443946	1235443946	1	1	JAGIRDAR, MAYURI S MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	153558	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
208006	Fee-for-Service	1225868094	1225868094	1	1	JHAJJ, RAMANPREET	9/25/2024	2279C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
208116	Fee-for-Service	1154344893	1154344893	1	1	JENG, LEO C MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77742	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
208188	Fee-for-Service	1184783755	1184783755	1	1	JOSEPH, ABRAHAM MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32846	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
208209	Fee-for-Service	1932640265	1932640265	1	1	JACKSON, BETHANY R DO	9/29/2023	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	21130	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
208241	Fee-for-Service	1083989065	1083989065	1	1	JIMENEZ, JANETTE LCSW	5/17/2022	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
208244	Fee-for-Service	1184900870	1184900870	1	1	JAGAJEEVAN, VEENA N NP	10/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208250	Fee-for-Service	1457377228	1457377228	1	1	JACOBY, PETER 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	56 FRANKLIN ST	None	WATERBURY	CT	06706	1253	00	None	41.55271355	-73.03590466	Naugatuck Valley Planning Region
208260	Fee-for-Service	1073992566	1073992566	1	1	JORDAN, ROGER MD	2/24/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
208309	Fee-for-Service	1629705249	1629705249	1	1	JUAREZ, KIMBERLY D NP	10/2/2023	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
208337	Fee-for-Service	1336305861	1336305861	1	1	JUDD, DAVID B PSYD	11/2/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
208393	Fee-for-Service	1447330709	1447330709	1	1	JACOB, SAPNA M MD	1/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52463	08	Family Practice	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
208421	Fee-for-Service	1770515769	1770515769	1	1	JOSEPH, MILDRED P NP	12/13/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
208435	Fee-for-Service	1922467752	1922467752	1	1	JAVAHERIAN, ANOOSH	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138559	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
208436	Fee-for-Service	1992155782	1992155782	1	1	JAMISON, NATHAN K MD	8/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	168935	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
208469	Fee-for-Service	1336375708	1336375708	1	1	JONES, TRESA M LCSW	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
208476	Fee-for-Service	1184783755	1184783755	1	1	JOSEPH, ABRAHAM MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32846	38	Geriatrics	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
208488	Fee-for-Service	1134224686	1134224686	1	1	JOHNSON,ALLEN 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	3-3420 KUHIO HIGHWAY	STE B	LIHUE	HI	96766	1098	00	None	21.98560043	-159.3663628	Kauai County
208623	Fee-for-Service	1679614218	1679614218	1	1	JONBEC CARE, INC	12/12/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LANCASTER HOUSE	1126 E CENTRAL AVE	None	REDLANDS	CA	92374	3722	36	06071	34.05723421	-117.1642443	San Bernardino County
208630	Fee-for-Service	1508834482	1508834482	1	1	JONES, H THOMAS MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	46697	14	Neurological Surgery	0	In state provider	None	2410 FLETCHER AVE	3RD FLOOR	SANTA BARBARA	CA	93105	4876	42	06083	34.43003406	-119.7251391	Santa Barbara County
208656	Fee-for-Service	1417933110	1417933110	1	1	JAKOBSEN, LARS J MD	8/31/1995	207R00000X	NA	Other	026	PHYSICIANS	77316	41	Internal Medicine	0	In state provider	None	3111 PROFESSIONAL DR	None	AUBURN	CA	95603	2456	31	06061	38.940327	-121.1007585	Placer County
208673	Fee-for-Service	1790045946	1790045946	1	1	JIMENEZ, JUAN M	4/7/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E CARNEGIE DRIVE	200	SAN BERNARDINO	CA	92408	4207	36	06071	34.0683677	-117.2746246	San Bernardino County
208676	Fee-for-Service	1912248915	1912248915	1	1	JAIN, SAURABH MD INC	9/24/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	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
208726	Fee-for-Service	1538205216	1538205216	2	1	J B FAR INC	1/8/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2699 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	4747	19	06037	33.97398526	-118.2224784	Los Angeles County
208757	Fee-for-Service	1598143083	1598143083	1	1	JAZAYERI, ALI R PSY	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26476	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
208794	Fee-for-Service	1528024825	1528024825	1	1	JODI S DASHE, 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
208842	Fee-for-Service	1396870630	1396870630	1	1	JOHNSON, ANETTE M MD	8/15/1982	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	24973	40	Pediatrics	0	In state provider	None	27862 PUERTA REAL #109	None	MISSION VIEJO	CA	92691	0000	30	06059	33.56849493	-117.6696298	Orange County
208942	Fee-for-Service	1750986196	1750986196	1	1	JOHNNY ARRUDA MD, INC.	3/4/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	RATION	255 TERRACINA BLVD	SUITE 201	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
209040	Fee-for-Service	1215118484	1215118484	1	1	JMAR HOMES INC	3/29/1998	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4613 SAN MIGUEL WAY	None	BAKERSFIELD	CA	93306	2347	15	06029	35.40104537	-118.9413856	Kern County
209051	Fee-for-Service	1164453718	1164453718	1	1	JOHN-KELLY, HELEN A MD	11/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54496	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
209214	Fee-for-Service	1134395205	1134395205	1	1	JOSEPH, JEFFREY M MD	6/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117073	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
209264	Fee-for-Service	1821132283	1821132283	1	1	JENNIFER R HALVERSON MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
209267	Fee-for-Service	1114500832	1114500832	1	1	JONES, KELCI OT	10/5/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
209318	Fee-for-Service	1437323359	1437323359	1	1	JOYESH SKARIA THOMAS	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
209384	Fee-for-Service	1376678359	1376678359	3	1	JJJA INC	4/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16550 VENTURA BLVD	#100	ENCINO	CA	91436	2004	19	06037	34.15778374	-118.4942662	Los Angeles County
209389	Fee-for-Service	1114218559	1114218559	1	1	JESSE J LICUANAN MD A	12/12/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL	3300 E SOUTH STREET	SUITE 205	LONG BEACH	CA	90805	4549	19	06037	33.86018093	-118.1537163	Los Angeles County
209488	Fee-for-Service	1982374955	1982374955	1	1	JEFFERS, AUSTIN PT	9/3/2024	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
209490	Fee-for-Service	1275739807	1275739807	1	1	J H WELLS MD PROF CORP	8/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	2880 ATLANTIC AVE	STE 290	LONG BEACH	CA	90806	1716	19	06037	33.809382	-118.185001	Los Angeles County
209566	Fee-for-Service	1073566428	1073566428	1	1	JUAREZ, GREGORY C MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81837	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
209620	Fee-for-Service	1093823700	1093823700	1	1	JONES, REBECCA K	3/4/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	127731	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	220 S PALISADE DR	STE 203	SANTA MARIA	CA	93454	8903	42	06083	34.95143521	-120.412098	Santa Barbara County
209717	Fee-for-Service	1124354584	1124354584	1	1	JAYANI, NISHA V MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129516	41	Internal Medicine	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
209776	Fee-for-Service	1801202221	1801202221	1	1	JERIS, DARLENE LCSW	5/28/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
209790	Fee-for-Service	1134654932	1134654932	1	1	JASINTO, MELISSA M MD	3/14/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	3131 LA CANADA STREET	SUITE 230	LAS VEGAS	NV	89169	2551	00	None	36.13267814	-115.132162	Clark County
209816	Fee-for-Service	1164409868	1164409868	1	1	JAMES TSAI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN STREET	None	PORTLAND	OR	97213	0000	00	None	45.52655191	-122.6121355	Multnomah County
209817	Fee-for-Service	1609002898	1609002898	1	1	JUREWITZ, DANIEL L MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107762	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2400 BATH ST	STE 201	SANTA BARBARA	CA	93105	4351	42	06083	34.43168847	-119.7234694	Santa Barbara County
209845	Fee-for-Service	1093731325	1093731325	1	1	JENSEN, DAVID R MD	6/30/1982	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	44704	01	General Practice	0	In state provider	None	17027 CLARK AVE	None	BELLFLOWER	CA	90706	5721	19	06037	33.879303	-118.133929	Los Angeles County
209850	Fee-for-Service	1457375800	1457375800	1	1	JIAGBOGU, CHUKWUEBUNIE	4/3/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LONG LIFE MEDICAL SUPPLY	428 W MANCHESTER BLVD	None	INGLEWOOD	CA	90301	1110	19	06037	33.96155982	-118.3631927	Los Angeles County
209856	Fee-for-Service	1952987612	1952987612	1	1	JUDNARINE, HILLARY S MD	9/27/2023	207P00000X	NA	Other	026	PHYSICIANS	187187	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
209874	Fee-for-Service	1265531248	1265531248	1	1	JAMES E RAGAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	710 CENTER ST	None	COLUMBUS	GA	31901	1527	00	None	32.48155062	-84.98153217	Muscogee County
209944	Fee-for-Service	1447839766	1447839766	1	1	JACKMAN, TRENTON D MD	2/21/2024	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
210105	Fee-for-Service	1609002898	1609002898	1	1	JUREWITZ, DANIEL L MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107762	41	Internal Medicine	0	In state provider	None	2400 BATH ST	STE 201	SANTA BARBARA	CA	93105	4351	42	06083	34.43168847	-119.7234694	Santa Barbara County
210116	Fee-for-Service	1104904887	1104904887	1	1	JOHNSTON, MAYNARD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37363	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
210182	Fee-for-Service	1598956856	1598956856	1	1	JOHNSON, KENNETH A 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
210224	Fee-for-Service	1477139418	1477139418	1	1	JULIET MUSOKE	4/13/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	22056 VISCANIO RD	None	WOODLAND HILLS	CA	91364	4110	19	06037	34.15605649	-118.6078095	Los Angeles County
210389	Fee-for-Service	1518149178	1518149178	2	1	JEANNE L BEAUX	9/9/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	52 LORRAINE ST	None	UKIAH	CA	95482	5946	23	06045	39.14073	-123.198341	Mendocino County
210391	Fee-for-Service	1881057248	1881057248	1	1	JUANG, JADE Y	11/8/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17909 W SOLEDAD CANYON R	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
210397	Fee-for-Service	1437190808	1437190808	1	1	JAYYOUSI, SARAH T LCSW	4/21/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1275 30TH STREET	None	SAN DIEGO	CA	92154	3476	37	06073	32.573178	-117.0689035	San Diego County
210415	Fee-for-Service	1912124686	1912124686	2	2	JOHNSON, KRISTIE LMFT	3/31/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2308 J STREET	SUITE D, OFFICE 2	SACRAMENTO	CA	95816	4718	34	06067	38.575188	-121.475565	Sacramento County
210512	Fee-for-Service	1477139418	1477139418	1	1	JULIET MUSOKE	4/13/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	22056 VISCANIO RD	None	WOODLAND HILLS	CA	91364	4110	19	06037	34.15605649	-118.6078095	Los Angeles County
210590	Fee-for-Service	1194268029	1194268029	1	1	JARRETT, JESSICA J	9/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
210599	Fee-for-Service	1407440670	1407440670	1	1	JIMENEZ, ANDREA L	1/4/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	600 PALM AVE	126	IMPERIAL BEACH	CA	91932	1246	37	06073	32.5839813	-117.1207525	San Diego County
210758	Fee-for-Service	1053578526	1053578526	1	1	JAMSHIDI, NAVID MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127886	68	Hematology	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
210832	Fee-for-Service	1598748170	1598748170	1	1	JOSLIN, CAROL J 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 STREET	None	PUEBLO	CO	81003	0000	00	None	38.28171999	-104.6119963	Pueblo County
210846	Fee-for-Service	1538553649	1538553649	1	1	JUDSON, TIMOTHY J MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148411	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
210866	Fee-for-Service	1407910995	1407910995	1	1	JORGENSEN, NEIL W MD	7/1/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72037	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
210867	Fee-for-Service	1629531116	1629531116	1	1	JOYE, ASHLIN DO MD	6/5/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	20929	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
210932	Fee-for-Service	1821102641	1821102641	1	1	JAIN, ADITYA MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53282	41	Internal Medicine	0	In state provider	None	1532 150TH AVE	None	SAN LEANDRO	CA	94578	1823	01	06001	37.70718429	-122.1274288	Alameda County
211024	Fee-for-Service	1528009503	1528009503	1	1	JUNG, VICTOR H MD	6/30/1987	2085R0001X	NA	Other	026	PHYSICIANS	40483	32	Radiation Therapy (D.O. only)	0	In state provider	None	1215 PLUMAS ST	STE 101	YUBA CITY	CA	95991	3453	51	06101	39.14709336	-121.6175316	Sutter County
211042	Fee-for-Service	1053578526	1053578526	1	1	JAMSHIDI, NAVID MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127886	78	Neoplastic Diseases/Oncology	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
211083	Fee-for-Service	1932158334	1932158334	1	1	JENSEN, KRISTIN C MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82218	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
211111	Fee-for-Service	1235167552	1235167552	1	1	JACOBS, SARA M	4/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	None	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
211123	Fee-for-Service	1528324787	1528324787	1	1	JANGOUK, PARASTOO MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155467	01	General Practice	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
211170	Fee-for-Service	1588770770	1588770770	1	1	JOHNSON, MARK K DPM	3/25/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 HAMMER LN	7B	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
211221	Fee-for-Service	1821102641	1821102641	1	1	JAIN, ADITYA MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53282	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1532 150TH AVE	None	SAN LEANDRO	CA	94578	1823	01	06001	37.70718429	-122.1274288	Alameda County
211258	Fee-for-Service	1164715686	1164715686	1	1	JAHANBAKHSH, BAHRAM	7/1/2024	207L00000X	NA	Other	026	PHYSICIANS	180862	05	Anesthesiology	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
211269	Fee-for-Service	1124120860	1124120860	1	1	JOTA, JOSE MD	1/30/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	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
211342	Fee-for-Service	1154436590	1154436590	1	2	JACKSON, TRACY P MD	3/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97159	-	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
211391	Fee-for-Service	1033896550	1033896550	1	1	JADE RESIDENTIAL CARE INC	8/9/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11821 FLAMINGO DRIVE	None	GARDEN GROVE	CA	92841	2657	30	06059	33.79112863	-117.9597231	Orange County
211412	Fee-for-Service	1528324787	1528324787	1	1	JANGOUK, PARASTOO MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155467	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
211456	Fee-for-Service	1861717175	1861717175	1	1	JOSEPH BOONSIRI	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
211551	Fee-for-Service	1285080135	1285080135	1	1	JONES, JENNIFER E MD	7/29/2020	207P00000X	NA	Other	026	PHYSICIANS	169410	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
211690	Fee-for-Service	1205846250	1205846250	1	1	JAIN, SARIKA MD	8/22/2001	174400000X	NA	Other	026	PHYSICIANS	76312	02	General Surgery	0	In state provider	None	160 E ARTESIA ST	STE 355	POMONA	CA	91767	2927	19	06037	34.07556833	-117.7507835	Los Angeles County
211812	Fee-for-Service	1629380233	1629380233	1	1	JAIME, LIZA L MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119212	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
211849	Fee-for-Service	1629319116	1629319116	1	1	JOSEPH, ELIZABETH A NP	8/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
212070	Fee-for-Service	1194501478	1194501478	1	1	JASON Y KIM MD INC	10/24/2023	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
212104	Fee-for-Service	1356504476	1356504476	1	1	JEW, JENNY F MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110315	10	Gastroenterology (M.D. only)	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
212110	Fee-for-Service	1700455599	1700455599	1	1	JOZWIAKOWSKI, ANDREW P MD	9/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	44	06087	36.98815433	-121.9571695	Santa Cruz County
212163	Fee-for-Service	1942468962	1942468962	1	1	JOO, JAYNE S MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109963	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
212236	Fee-for-Service	1346229382	1346229382	1	1	JACKSON, BRENT C MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64902	02	General Surgery	0	In state provider	None	7930 FROST ST	STE 101	SAN DIEGO	CA	92123	2756	37	06073	32.80027001	-117.1532893	San Diego County
212272	Fee-for-Service	1912987314	1912987314	1	1	JACOBY, GAIL T MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	25405	07	Dermatology	0	In state provider	None	1036 LAUREL ST	None	SAN CARLOS	CA	94070	3919	41	06081	37.50072877	-122.2542403	San Mateo County
212425	Fee-for-Service	1811064637	1811064637	1	1	JOHNSON, STEPHEN R MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40089	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212483	Fee-for-Service	1053726695	1053726695	1	1	JEN, NA DO	8/17/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	16741	None	None	0	In state provider	None	1600 E FLORIDA AVE	103	HEMET	CA	92544	8643	33	06065	33.74768747	-116.9557425	Riverside County
212510	Fee-for-Service	1093785925	1093785925	1	1	JAMES HOYT M.D.	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 ROCKY MOUNTAIN AVE	None	LOVELAND	CO	80538	9004	00	None	40.415778	-104.99715	Larimer County
212524	Fee-for-Service	1346229382	1346229382	1	1	JACKSON, BRENT C MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64902	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7930 FROST ST	STE 101	SAN DIEGO	CA	92123	2756	37	06073	32.80027001	-117.1532893	San Diego County
212603	Fee-for-Service	1164951778	1164951778	1	1	JENSEN, CHAD M MD	5/9/2022	207PE0004X	NA	Other	026	PHYSICIANS	177763	None	None	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
212658	Fee-for-Service	1598562076	1598562076	1	1	JIANG, JAMES C MD	3/31/2025	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
212660	Fee-for-Service	1386148534	1386148534	1	1	JONES, DOUGLAS DO	4/7/2025	2080P0203X	NA	Other	026	PHYSICIANS	19163	40	Pediatrics	0	In state provider	None	9900 STOCKDALE HWY	STE 104	BAKERSFIELD	CA	93311	3633	15	06029	35.35412167	-119.1124089	Kern County
212671	Fee-for-Service	1295210672	1295210672	1	1	JAUREGUI, MYCHAEL P LMFT	10/8/2024	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
212715	Fee-for-Service	1811064637	1811064637	1	1	JOHNSON, STEPHEN R MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40089	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
212749	Fee-for-Service	1598922965	1598922965	1	1	JUCO, CHRISTY LEE S PT	7/20/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
212779	Fee-for-Service	1013396340	1013396340	1	1	JOHNSON, COULSANDER	7/1/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2090 MYRTLE AVE	None	LONG BEACH	CA	90806	4932	19	06037	33.79514291	-118.1817621	Los Angeles County
212783	Fee-for-Service	1386007698	1386007698	1	1	JARMAKANI, HADDY M DO	5/26/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18698	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
212786	Fee-for-Service	1861902280	1861902280	1	3	JULIA EVANS PHD PSYCHOLOGY P	10/7/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	940 S COAST DR STE 225	None	COSTA MESA	CA	92626	7757	30	06059	33.68993791	-117.8953504	Orange County
212851	Fee-for-Service	1124206487	1124206487	1	1	JACKSON, BRADLEY A MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115326	30	Radiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
212852	Fee-for-Service	1679846190	1679846190	1	1	JIMENEZ, ARTHUR E MD INC	1/24/2013	193400000X	NA	Other	026	PHYSICIANS	64270	None	None	0	In state provider	None	15381 7TH ST	STE 2-3	VICTORVILLE	CA	92395	3858	36	06071	34.53171716	-117.2981568	San Bernardino County
212976	Fee-for-Service	1851389738	1851389738	1	1	JOONG,M AHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
213068	Fee-for-Service	1013396340	1013396340	1	1	JOHNSON, COULSANDER	7/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2090 MYRTLE AVE	None	LONG BEACH	CA	90806	4932	19	06037	33.79514291	-118.1817621	Los Angeles County
213162	Fee-for-Service	1326383670	1326383670	1	1	JUNG, PETER CHIROPRACTIC INC	10/1/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	520 N BROOKHURST ST	STE 102	ANAHEIM	CA	92801	8826	30	06059	33.838974	-117.959013	Orange County
213203	Fee-for-Service	1841236510	1841236510	1	1	JOHN WRIGHT	3/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 BLUEGRASS CIR	None	CHEYENNE	WY	82009	7329	00	None	41.15880388	-104.7925312	Laramie County
213368	Fee-for-Service	1720349137	1720349137	1	1	JANARIOUS, DAVID G MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129075	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
213444	Fee-for-Service	1063651552	1063651552	1	1	JALISI, NEJAT A MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105304	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
213464	Fee-for-Service	1497041982	1497041982	1	1	JERSON MUNOZ MENDOZA MD	4/5/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 SPRINGHILL DR	None	N LITTLE ROCK	AR	72117	2922	00	None	34.783704	-92.2230765	Pulaski County
213561	Fee-for-Service	1992915953	1992915953	1	1	JASMINE BADILLO AND TERESITA	8/5/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	REYES	100 MORGAN CT	None	VALLEJO	CA	94591	8452	48	06095	38.12915763	-122.2190662	Solano County
213670	Fee-for-Service	1215790910	1215790910	1	1	JAXON PHARMACY, LLC	3/1/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18777 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2949	19	06037	33.98792721	-117.8948877	Los Angeles County
213701	Fee-for-Service	1275534158	1275534158	1	1	JOSE C DE SOUZA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1297 BURNS WAY	STE 4	KALISPELL	MT	59901	0000	00	None	48.213279	-114.3255555	Flathead County
213798	Fee-for-Service	1912000449	1912000449	1	1	JHANSI, MUSUVATHY S MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	37024	41	Internal Medicine	0	In state provider	None	2801 K STREET	SUITE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
213816	Fee-for-Service	1770517666	1770517666	1	1	JACKSON, GEORGE M MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	39327	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
213957	Fee-for-Service	1982133260	1982133260	1	1	JHAVERI, VIDHI S MD	7/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158831	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
214083	Fee-for-Service	1265446926	1265446926	1	1	JULIA TIMBERLAKE	3/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
214103	Fee-for-Service	1770517666	1770517666	1	1	JACKSON, GEORGE M MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	39327	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
214117	Fee-for-Service	1437237104	1437237104	1	1	JAMES, RON E MD	4/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68031	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
214132	Fee-for-Service	1821232216	1821232216	1	1	JESSIE M PETTIT, 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
214164	Fee-for-Service	1639450638	1639450638	1	1	JOHNSON, SARA W MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	117896	66	Emergency Medicine (Urgent Care)	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
214253	Fee-for-Service	1326328444	1326328444	1	1	JAFFE, ROBERT J MD	1/10/2013	207R00000X	NA	Other	026	PHYSICIANS	34013	41	Internal Medicine	0	In state provider	None	9375 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
214287	Fee-for-Service	1932465358	1932465358	1	1	JUDY LOCATI	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
214295	Fee-for-Service	1760680896	1760680896	1	1	JAFRI, FATIMA MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104688	41	Internal Medicine	0	In state provider	None	2261 DOUGLAS BLVD	STE 100	ROSEVILLE	CA	95661	2691	31	06061	38.74434897	-121.2413247	Placer County
214372	Fee-for-Service	1184941072	1184941072	1	1	JAQUES, CORY D MD	8/18/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	118914	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
214423	Fee-for-Service	1326517426	1326517426	1	1	JONES, KATIE L	8/31/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	40700 CALIFORNIA OAKS RD	STE. 108	MURRIETA	CA	92562	5727	33	06065	33.57067363	-117.2045035	Riverside County
214488	Fee-for-Service	1649598632	1649598632	2	1	JOSHUA TREE EMERGENCY	8/15/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	250 N FIRST STREET	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
214658	Fee-for-Service	1831365998	1831365998	1	1	JOSHI, RAJESH K MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
214817	Fee-for-Service	1699490136	1699490136	1	1	JOSEPH SHERIDAN MD INC	11/7/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
214851	Fee-for-Service	1225272974	1225272974	1	2	JAMES, ELVIRA LYDIA	8/4/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16191 OLALEE RD	None	APPLE VALLEY	CA	92307	1428	36	06071	34.54573607	-117.2608048	San Bernardino County
214869	Fee-for-Service	1235283581	1235283581	1	1	JASON ELI FARRAR M.D.	9/23/2015	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	3500	00	None	34.742745	-92.2927905	Pulaski County
214881	Fee-for-Service	1639409139	1639409139	1	1	JAFARI, OMID MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110476	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
214898	Fee-for-Service	1194901025	1194901025	1	1	JAYASINHA, YASANGI M MD	9/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95229	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
214947	Fee-for-Service	1922186766	1922186766	1	1	JOSEPH, MARALEE MD	3/17/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73645	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
214950	Fee-for-Service	1255567087	1255567087	1	1	JASON EISENBERG	2/26/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
214952	Fee-for-Service	1265510838	1265510838	1	1	JOSHI, SANGEETA MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89576	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
215053	Fee-for-Service	1518719806	1518719806	1	1	JOUGHEH DOUST, SOGHRA MD	4/2/2024	207SG0201X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
215096	Fee-for-Service	1437783677	1437783677	1	1	JLAB INC	9/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10650 54TH STREET	None	MIRA LOMA	CA	91752	2234	33	06065	33.98994859	-117.5179578	Riverside County
215109	Fee-for-Service	1629643002	1629643002	1	1	JENSEN, ALLISON LMFT	5/17/2024	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
215139	Fee-for-Service	1225272974	1225272974	1	2	JAMES, ELVIRA LYDIA	8/4/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16191 OLALEE RD	None	APPLE VALLEY	CA	92307	1428	36	06071	34.54573607	-117.2608048	San Bernardino County
215195	Fee-for-Service	1023641081	1023641081	1	1	JENNIFER CHOKEMESIL, LMFT, M	2/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ARRIAGE AND FAMILY THERA	4030 PALOS VERDES DR N	STE 106	ROLLING HILLS EST	CA	90274	2560	19	06037	33.78278882	-118.352888	Los Angeles County
215283	Fee-for-Service	1548905508	1548905508	1	1	JOE, KARISA OT	5/5/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
215305	Fee-for-Service	1275530529	1275530529	1	1	JOHAL, DHARAMPAL S MD	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	56018	41	Internal Medicine	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
215315	Fee-for-Service	1326006966	1326006966	1	1	JULES STEIN EYE INSTITUTE ME	3/1/2001	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
215359	Fee-for-Service	1346501137	1346501137	1	1	JWO, KEVIN MD	9/29/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148737	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
215361	Fee-for-Service	1376937367	1376937367	1	1	JACOBS, LISA R MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149687	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
215587	Fee-for-Service	1346531027	1346531027	1	1	JAHN, KARISA A DO	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11079	38	Geriatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
215592	Fee-for-Service	1275530529	1275530529	1	1	JOHAL, DHARAMPAL S MD	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	56018	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7011 N HOWARD ST	STE 201	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
215604	Fee-for-Service	1326006966	1326006966	1	1	JULES STEIN EYE INSTITUTE ME	7/20/1992	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
215615	Fee-for-Service	1629047964	1629047964	1	1	JEYAKUMAR, PANCHARATNAM	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42736	41	Internal Medicine	0	In state provider	MD	101 CITY DRIVE S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
215633	Fee-for-Service	1346826419	1346826419	1	1	JONES, SHANE MD	6/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190612	08	Family Practice	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
215696	Fee-for-Service	1447276530	1447276530	1	1	JAHNKE, LYNNE MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	66827	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
215742	Fee-for-Service	1003319609	1003319609	1	1	JONES, AMBER DO MPH	4/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12558	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
215825	Fee-for-Service	1013237445	1013237445	1	1	JANIGIAN, DENA M MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101348	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DRIVE	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
215891	Fee-for-Service	1326006966	1326006966	1	1	JULES STEIN EYE INSTITUTE ME	4/2/2018	152W00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
215899	Fee-for-Service	1629047964	1629047964	1	1	JEYAKUMAR, PANCHARATNAM	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42736	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	101 CITY DRIVE S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
215929	Fee-for-Service	1649793720	1649793720	1	1	JOU SANTACREU, JOAN	10/24/2018	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
215998	Fee-for-Service	1457362261	1457362261	1	1	JAMBOOR MEDICAL CORPORATION	3/1/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	655 S. 7TH AVE	None	BARSTOW	CA	92311	3001	36	06071	34.89160156	-117.0195901	San Bernardino County
216031	Fee-for-Service	1003319609	1003319609	1	1	JONES, AMBER DO MPH	4/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12558	89	Surgery-Traumatic	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
216055	Fee-for-Service	1467647479	1467647479	1	1	JAIN, NEETA MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93393	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
216063	Fee-for-Service	1144569617	1144569617	1	1	JOURNEY HOSPICE SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	500 E OLIVE AVE	STE 710	BURBANK	CA	91501	2184	19	06037	34.1845331	-118.3048131	Los Angeles County
216090	Fee-for-Service	1568091106	1568091106	1	1	JOHN, ANDREW J MD	8/26/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216199	Fee-for-Service	1801835996	1801835996	1	1	JIANG, SHANG I B MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87333	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
216205	Fee-for-Service	1366442907	1366442907	1	1	JOHNSON, CHRISTOPHER 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	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
216244	Fee-for-Service	1619674553	1619674553	1	1	JENSEN, REBECCA E PT	2/24/2023	225100000X	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
216252	Fee-for-Service	1750727277	1750727277	1	1	JERVIS YAU, M.D., INC.	12/15/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2936 DE LA VINA ST	FIRST AND SECOND FLOORS	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
216255	Fee-for-Service	1154509206	1154509206	1	1	JAYASHANKAR, ASHOK A MD	11/5/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	103934	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
216275	Fee-for-Service	1750962122	1750962122	1	1	JONES, JENNIFER S LMFT	7/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2435 VENTURA BLVD	STE D	CAMARILLO	CA	93010	6697	56	06111	34.21636822	-119.0374079	Ventura County
216291	Fee-for-Service	1609908276	1609908276	1	1	JACOBI, NEAL H MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42897	36	Psychiatry	0	In state provider	None	3862 HAPPY VALLEY RD	None	LAFAYETTE	CA	94549	2434	07	06013	37.90544384	-122.1428599	Contra Costa County
216319	Fee-for-Service	1407023922	1407023922	1	1	JOHNSON, CARY A MD	10/31/2018	207ZP0102X	NA	Other	026	PHYSICIANS	158492	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
216350	Fee-for-Service	1144569617	1144569617	1	1	JOURNEY HOSPICE SERVICES INC	1/27/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	500 E OLIVE AVE	STE 710	BURBANK	CA	91501	2184	19	06037	34.1845331	-118.3048131	Los Angeles County
216419	Fee-for-Service	1861448029	1861448029	1	1	JOHNSON, SHANNON K CNM	4/27/2015	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	329 W 8TH STREET	SUITE 101	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
216420	Fee-for-Service	1710213608	1710213608	1	1	JEHNSEN, JULIE L NP	9/27/2021	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
216440	Fee-for-Service	1538165279	1538165279	1	1	JAMES LEGGETT 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	STE 540	PORTLAND	OR	97213	0000	00	None	45.52717448	-122.611527	Multnomah County
216575	Fee-for-Service	1609155365	1609155365	1	1	JESSEE, SHANNON LMFT	11/24/2020	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
216639	Fee-for-Service	1063564748	1063564748	1	1	JACKSON, DAVID B MD	9/30/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68901	None	None	0	In state provider	None	2632 E WASHINGTON BLVD	None	PASADENA	CA	91107	1411	19	06037	34.1691255	-118.096119	Los Angeles County
216683	Fee-for-Service	1376935478	1376935478	1	1	JIANG, AMY Z MD	12/10/2021	207RR0500X	NA	Other	026	PHYSICIANS	172197	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
216763	Fee-for-Service	1750818175	1750818175	1	2	JEFFREY R HODGSON MD CORPORA	7/23/2020	207LP2900X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	TION	637 ROMIE	None	SALINAS	CA	93901	4205	27	06053	36.65929892	-121.6431671	Monterey County
216816	Fee-for-Service	1235330440	1235330440	1	1	JAVARI, NATHAN A DPM INC	1/1/2003	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	231 W VERNON AVE	STE 109	LOS ANGELES	CA	90037	2778	19	06037	34.0038305	-118.2774195	Los Angeles County
216831	Fee-for-Service	1083856710	1083856710	1	1	JULIANO, DIONICE S MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
216847	Fee-for-Service	1053046912	1053046912	1	1	JAVA, JENNIFER A	2/27/2023	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
216861	Fee-for-Service	1952346660	1952346660	1	1	JAGGY, JAKOB MD	9/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66760	08	Family Practice	0	In state provider	None	22603 PARROTTS FERRY RD	None	COLUMBIA	CA	95310	9726	55	06109	38.03255764	-120.4044175	Tuolumne County
216951	Fee-for-Service	1962424721	1962424721	1	1	JANSEN, WAYNE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 BURDICK EXPY W	None	MINOT	ND	58701	4406	00	None	48.2325845	-101.2938165	Ward County
216958	Fee-for-Service	1164534269	1164534269	1	1	JAGANNATHAN, PRIYA MD	2/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115086	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
216973	Fee-for-Service	1558686477	1558686477	1	1	JEANTY, CERINE MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118856	02	General Surgery	0	In state provider	None	2250 HAYES ST	STE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
217051	Fee-for-Service	1417985581	1417985581	1	1	JIH, WILLIAM W MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73401	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
217067	Fee-for-Service	1053495150	1053495150	1	1	JACOBS, EMILY M LCSW	6/6/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 N MAIN ST	None	JACKSON	CA	95642	2332	03	06005	38.35080235	-120.7750013	Amador County
217072	Fee-for-Service	1023171501	1023171501	1	1	JANDALI, AMER MD INC	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49316	41	Internal Medicine	0	In state provider	None	23110 ATLANTIC CIR	STE A	MORENO VALLEY	CA	92553	5920	33	06065	33.93308206	-117.2597707	Riverside County
217095	Fee-for-Service	1760487375	1760487375	1	1	JULIAN, ROBERT MD JR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33145	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
217146	Fee-for-Service	1023107257	1023107257	1	1	JAIN, ANAGHA V MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70147	45	Nephrology (Renal-Kidney)	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
217197	Fee-for-Service	1861495756	1861495756	1	1	JAIN, RINA MD	11/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81238	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
217286	Fee-for-Service	1477946358	1477946358	1	1	JANET URQUIZU, PSYCHOLOGY CO	5/6/2019	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	NSULTANT INC.	6700 FALLBROOK AVE	SUITE 111B	WEST HILLS	CA	91307	3540	19	06037	34.192332	-118.623381	Los Angeles County
217299	Fee-for-Service	1205848157	1205848157	1	1	JEFFREY P OTJEN, MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
217359	Fee-for-Service	1023171501	1023171501	1	1	JANDALI, AMER MD INC	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49316	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23110 ATLANTIC CIR	STE A	MORENO VALLEY	CA	92553	5920	33	06065	33.93308206	-117.2597707	Riverside County
217384	Fee-for-Service	1912195603	1912195603	1	1	JONES, VALERIE A MD	9/30/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	115945	None	None	0	In state provider	None	850 FAIR OAKS	SUITE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
217434	Fee-for-Service	1023107257	1023107257	1	1	JAIN, ANAGHA V MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70147	41	Internal Medicine	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
217487	Fee-for-Service	1861495756	1861495756	1	1	JAIN, RINA MD	11/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81238	20	Orthopedic Surgery	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
217524	Fee-for-Service	1619111531	1619111531	2	1	JANG, SHAUN E MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
217539	Fee-for-Service	1952861130	1952861130	1	1	JIN, SHAWN MD	9/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	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
217566	Fee-for-Service	1215190541	1215190541	1	1	JONES, CHRISTINA D MD	10/17/2019	207R00000X	NA	Other	026	PHYSICIANS	158408	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
217572	Fee-for-Service	1750483061	1750483061	1	1	JOSHI, DARIUS K MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142805	38	Geriatrics	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
217573	Fee-for-Service	1841408572	1841408572	1	1	JASON D MORROW, 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
217574	Fee-for-Service	1235186347	1235186347	1	1	JAFARI, ALIREZA MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49135	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9209 COLIMA RD	STE 4100	WHITTIER	CA	90605	1826	19	06037	33.9505367	-118.0054552	Los Angeles County
217712	Fee-for-Service	1255381125	1255381125	1	1	JACOBSON, ARTHUR I MD	1/1/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	35678	18	Ophthalmology	0	In state provider	None	6317 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90048	4878	19	06037	34.06351974	-118.3660271	Los Angeles County
217821	Fee-for-Service	1457814295	1457814295	1	1	JIANG, EILEEN	3/9/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179414	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
217829	Fee-for-Service	1235236308	1235236308	1	1	JACKSON, DAVID N MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3006 S MARYLAND PARKWAY	# 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
217845	Fee-for-Service	1528127503	1528127503	1	1	JAGGER, ROBERT L MD	12/31/1983	146D00000X	NA	Other	026	PHYSICIANS	28548	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
217857	Fee-for-Service	1235186347	1235186347	1	1	JAFARI, ALIREZA MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49135	41	Internal Medicine	0	In state provider	None	9209 COLIMA RD	STE 4100	WHITTIER	CA	90605	1826	19	06037	33.9505367	-118.0054552	Los Angeles County
217919	Fee-for-Service	1992837926	1992837926	1	1	JOHNSON, YEVA M MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72818	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
217952	Fee-for-Service	1386252849	1386252849	1	1	JUNG, LIANDRA OD	1/22/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
217962	Fee-for-Service	1073541462	1073541462	1	1	JACQUES, SUNIL B MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	87006	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
217981	Fee-for-Service	1720426893	1720426893	1	2	JS CAPITOL GROUP	8/4/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2089 VALE ROAD	STE 31	SAN PABLO	CA	94806	3850	07	06013	37.95396781	-122.3375393	Contra Costa County
218063	Fee-for-Service	1942287859	1942287859	1	1	JURAVSKY, LOUIS I MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86728	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
218134	Fee-for-Service	1528127503	1528127503	1	1	JAGGER, ROBERT L MD	12/31/1983	146D00000X	NA	Other	026	PHYSICIANS	28548	01	General Practice	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
218154	Fee-for-Service	1619073608	1619073608	1	1	JAHAN, CAROLYN K LMFT	11/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	161 AVENIDA CABRILLO	None	SAN CLEMENTE	CA	92672	4040	30	06059	33.42676419	-117.6151632	Orange County
218163	Fee-for-Service	1164756573	1164756573	1	1	JAMALI, SAKINA A OD	12/8/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7301 MEDICAL CENTER DR	STE 410	WEST HILLS	CA	91307	1994	19	06037	34.20285756	-118.6294575	Los Angeles County
218259	Fee-for-Service	1760809925	1760809925	1	1	JENG-LIN, JENNIFER C DPM	8/8/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	19	06037	37.33636857	-121.9958111	Santa Clara County
218272	Fee-for-Service	1275844375	1275844375	1	1	JALAL, TABISH MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133937	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
218291	Fee-for-Service	1114418209	1114418209	1	1	JOSEPH, ALBERLETIA L NP	6/3/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
218786	Fee-for-Service	1528301637	1528301637	1	1	JEX, MARSHALL R DPM	10/21/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
218801	Fee-for-Service	1053682971	1053682971	1	1	JIANG, BOWEN MD	7/30/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	168233	14	Neurological Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
218943	Fee-for-Service	1730358789	1730358789	1	1	JACK CE JI DO	5/20/2013	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
218952	Fee-for-Service	1619288149	1619288149	1	1	JONES, ERIN E MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115611	01	General Practice	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
218972	Fee-for-Service	1801946447	1801946447	1	1	JUDKINS, ALEXANDER R MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54257	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
218992	Fee-for-Service	1720218761	1720218761	1	1	JOSEFSON, ELLIE LMFT	9/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 BROADWAY	SUITE 200	SANTA MONICA	CA	90401	2330	19	06037	34.01334753	-118.4957836	Los Angeles County
219062	Fee-for-Service	1700876992	1700876992	1	1	JONES, CHRISTOPHER B MD	8/18/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	172830	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
219106	Fee-for-Service	1043506348	1043506348	1	1	JANAY, JAN B MD	6/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127001	01	General Practice	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	5055	19	06037	34.41257644	-118.5597683	Los Angeles County
219130	Fee-for-Service	1154329407	1154329407	1	1	JACOBSON, ANDREW W MD	12/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	90312	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
219191	Fee-for-Service	1023372547	1023372547	1	1	JALIL, JASON MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132082	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
219238	Fee-for-Service	1619288149	1619288149	1	1	JONES, ERIN E MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115611	08	Family Practice	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
219276	Fee-for-Service	1063241255	1063241255	1	1	JACKSON, TERRANCE NP	1/13/2025	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
219303	Fee-for-Service	1891711289	1891711289	1	1	JACKSON AND ENGBERG MEDICAL	10/18/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	517 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4239	42	06083	34.42887266	-119.725938	Santa Barbara County
219340	Fee-for-Service	1538260229	1538260229	1	1	J. ARTHUR DOSHER	4/9/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	924 N HOWE ST	None	SOUTHPORT	NC	28461	3038	00	None	33.9294213	-78.02228911	Brunswick County
219401	Fee-for-Service	1033786645	1033786645	1	1	JU, TIFFANY PHD	3/21/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
219421	Fee-for-Service	1679870794	1679870794	1	1	JURICH, JORIETH M DO	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12951	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	SUITE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
219467	Fee-for-Service	1508856220	1508856220	1	1	JABARA, SAMI I MD	12/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54168	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
219539	Fee-for-Service	1740306372	1740306372	1	1	JUELS, CHRISTOPHER R MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69737	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
219592	Fee-for-Service	1891711289	1891711289	1	1	JACKSON AND ENGBERG MEDICAL	10/18/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	517 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4239	42	06083	34.42887266	-119.725938	Santa Barbara County
219619	Fee-for-Service	1063989028	1063989028	1	1	JUVAN HOSPICE AND PALLIATIVE	5/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE	7111 GARDEN GROVE BLVD	SUITE 210	GARDEN GROVE	CA	92841	4231	30	06059	33.77447223	-118.0087819	Orange County
219631	Fee-for-Service	1871628834	1871628834	1	1	JORDAN, JUDY LMFT	9/9/2021	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
219669	Fee-for-Service	1366528879	1366528879	1	1	JUE, RENATA M MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82480	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
219702	Fee-for-Service	1740851385	1740851385	1	1	J.L. ARTIFICIAL LIMB & BRACE	9/9/2021	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	1	Border provider	None	1744 HIGHWAY 95	SUITE 2	BULLHEAD CITY	AZ	86442	6981	00	None	35.121537	-114.585147	Mohave County
219755	Fee-for-Service	1013967314	1013967314	2	1	JSI ACQUISITION, INC	1/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5805 SEPULVEDA BLVD	SUITE 605	VAN NUYS	CA	91411	2550	19	06037	34.176339	-118.466186	Los Angeles County
219770	Fee-for-Service	1770849531	1770849531	1	1	JOSHI, ALISHA S PT	3/3/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 N CENTRAL AVE.	SUITE 110	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
219907	Fee-for-Service	1063989028	1063989028	1	1	JUVAN HOSPICE AND PALLIATIVE	5/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE	7111 GARDEN GROVE BLVD	SUITE 210	GARDEN GROVE	CA	92841	4231	30	06059	33.77447223	-118.0087819	Orange County
219954	Fee-for-Service	1871660878	1871660878	1	1	JUSTER, DEBORAH A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39828	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
220041	Fee-for-Service	1891163804	1891163804	1	1	JONATHAN PROCTER, PHD	8/16/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRONT ST	STE 10	ROCKVILLE CTR	NY	11570	4040	00	None	40.658652	-73.6452315	Nassau County
220043	Fee-for-Service	1013967314	1013967314	2	1	JSI ACQUISITION, INC	7/1/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5805 SEPULVEDA BLVD	SUITE 605	VAN NUYS	CA	91411	2550	19	06037	34.176339	-118.466186	Los Angeles County
220137	Fee-for-Service	1609860295	1609860295	1	1	JOHANSEN, ROBERT PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17215 STUDEBAKER RD	STE 110	CERRITOS	CA	90703	2521	19	06037	33.874686	-118.0998595	Los Angeles County
220141	Fee-for-Service	1174652473	1174652473	1	1	JAGGER, SUZANNE CRNA	3/16/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
220149	Fee-for-Service	1164625034	1164625034	1	1	JENKINS, AISHA K LPCC	8/21/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
220204	Fee-for-Service	1457591406	1457591406	1	1	JUNG, APRIL M MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105750	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
220241	Fee-for-Service	1871660878	1871660878	1	1	JUSTER, DEBORAH A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39828	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
220274	Fee-for-Service	1902983844	1902983844	1	1	JUE, BILL M MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58406	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
220327	Fee-for-Service	1174629166	1174629166	1	1	JAFARI, GOLRIZ MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70140	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
220353	Fee-for-Service	1013967314	1013967314	2	1	JSI ACQUISITION, INC	4/1/2010	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	5805 SEPULVEDA BLVD	SUITE 605	VAN NUYS	CA	91411	2550	19	06037	34.176339	-118.466186	Los Angeles County
220382	Fee-for-Service	1508404609	1508404609	1	1	JANETS ENTERPRISE INC	7/13/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6120 BUCHANAN AVE	None	SAN BERNARDINO	CA	92404	3415	36	06071	34.14274832	-117.2417449	San Bernardino County
220455	Fee-for-Service	1912960758	1912960758	1	1	JACKSON COUNTY PUBLIC HOSP	1/18/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 W GROVE ST	None	MAQUOKETA	IA	52060	2163	00	None	42.07367852	-90.673344	Jackson County
220524	Fee-for-Service	1427486158	1427486158	1	1	J HERNDONS LLC	5/22/2018	261QR0401X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	69730 HWY 111	SUITE 109	RANCHO MIRAGE	CA	92270	4042	33	06065	33.7728798	-116.4474207	Riverside County
220578	Fee-for-Service	1114195146	1114195146	1	1	JOHNSON, APRIL	5/5/2020	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
220622	Fee-for-Service	1326006966	1326006966	1	2	JULES STEIN EYE INSTITUTE ME	6/28/2019	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DICAL GROUP	1250 16TH ST.	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
220638	Fee-for-Service	1073876017	1073876017	1	1	JOHNSON, ASHER I PSYD	10/25/2023	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
220713	Fee-for-Service	1477618452	1477618452	1	1	JAFARI, MAHINDOKHT DO	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6716	40	Pediatrics	0	In state provider	None	855 N LARK ELLEN AVE	STE A	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
220719	Fee-for-Service	1588130959	1588130959	1	1	JENKINS, SARAH D CCC-SLP	1/20/2025	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
220720	Fee-for-Service	1144427139	1144427139	1	1	JACKSON, JENNIFER E MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109838	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
220749	Fee-for-Service	1003802547	1003802547	1	1	JUANG,GEORGE	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
220871	Fee-for-Service	1053632299	1053632299	1	1	JAISWAL, SIDDHARTHA MD	10/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151796	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
220952	Fee-for-Service	1528128949	1528128949	1	2	JACOB, SAID I MD	10/27/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	43666	-	NOT APPLICABLE	0	In state provider	None	453 S INDIANA ST	None	LOS ANGELES	CA	90063	3908	19	06037	34.030728	-118.192386	Los Angeles County
220974	Fee-for-Service	1346273406	1346273406	1	1	JAMALI, MEHRNAZ N MD	3/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53933	None	None	0	In state provider	None	600 CITY PARKWAY WEST	STE 400	ORANGE	CA	92868	2900	30	06059	33.78299646	-117.89694	Orange County
221046	Fee-for-Service	1124194980	1124194980	1	1	JENKINS, MORGAN R MD	7/22/2013	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	57608	40	Pediatrics	0	In state provider	None	WEST 5TH AVE & ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.741948	-121.848921	Butte County
221209	Fee-for-Service	1891746574	1891746574	1	1	JASMER, ROBERT M MD	12/11/2002	207RP1001X	NA	Pulmonology	026	PHYSICIANS	72423	01	General Practice	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
221332	Fee-for-Service	1588983134	1588983134	1	1	JIA, JUDY J MD	10/8/2019	2084V0102X	NA	Neurology	026	PHYSICIANS	162475	13	Neurology (M.D. only)	0	In state provider	None	1375 SUTTER ST	208	SAN FRANCISCO	CA	94109	5465	38	06075	37.78738239	-122.4229066	San Francisco County
221333	Fee-for-Service	1255952677	1255952677	1	1	JUDGE, GAGANDIP LPCC	10/11/2023	101YP2500X	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
221368	Fee-for-Service	1689739369	1689739369	1	1	JERNICK, JOHN J MD	12/29/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49839	08	Family Practice	0	In state provider	None	704 WEBSTER ST	None	PALO ALTO	CA	94301	2628	43	06085	37.44781183	-122.1553126	Santa Clara County
221387	Fee-for-Service	1083629828	1083629828	1	1	JAMES THOMAS DANE MD	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1134 N 500 W	STE 100	PROVO	UT	84604	6101	00	None	40.249728	-111.667381	Utah County
221447	Fee-for-Service	1073035440	1073035440	1	1	JAVALI, SHRUTI MD	11/2/2020	208M00000X	NA	Other	026	PHYSICIANS	169683	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
221453	Fee-for-Service	1396823993	1396823993	1	1	JOHNSON, PAUL M MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67941	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
221465	Fee-for-Service	1225101470	1225101470	1	1	JOHNS SHOP-RITE PHARMACY INC	6/3/1994	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	JOHN'S SHOP-RITE PHMCY	4333 SOUTH ST	None	LAKEWOOD	CA	90712	1148	19	06037	33.86046642	-118.1410856	Los Angeles County
221503	Fee-for-Service	1215464888	1215464888	1	1	JAYADEVA, VIKAS K MD	3/18/2019	390200000X	NA	Other	026	PHYSICIANS	159193	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
221670	Fee-for-Service	1285917195	1285917195	1	1	JULIA GROSSMAN, 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
221686	Fee-for-Service	1972137149	1972137149	1	1	JABER, AMAIR LCSW	11/5/2020	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
221690	Fee-for-Service	1740346832	1740346832	1	1	JIMENEZ, JOANNE 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
221759	Fee-for-Service	1154436590	1154436590	1	1	JACKSON, TRACY P MD	12/2/2019	207LP2900X	NA	Other	026	PHYSICIANS	97159	05	Anesthesiology	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
221902	Fee-for-Service	1962541961	1962541961	1	1	JOSHUA ERIC ROBERTSON 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
221925	Fee-for-Service	1649247610	1649247610	1	1	JOE, SHARON M OD	8/24/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
222013	Fee-for-Service	1548392871	1548392871	1	1	JAMISON, MICHAEL T MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55012	06	Cardiovascular Disease (M.D. only)	0	In state provider	TOT CARD HLTH OF VEN MED	2001 N SOLAR DR	SUITE 210	OXNARD	CA	93036	2645	56	06111	34.22025454	-119.1449192	Ventura County
222065	Fee-for-Service	1003194853	1003194853	1	1	JOHNSTON, ROBERT C MD	10/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125165	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
222111	Fee-for-Service	1881619807	1881619807	1	1	JENKINS, STEPHEN W MD	7/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	33637	13	Neurology (M.D. only)	0	In state provider	None	9940 TALBERT AVE	STE 204	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
222123	Fee-for-Service	1093099046	1093099046	1	2	JUN R. CHIONG, MD, MPH, INC.	7/19/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
222136	Fee-for-Service	1023270774	1023270774	1	1	JONATHAN S KIM M.D.	3/11/2015	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
222212	Fee-for-Service	1396767604	1396767604	1	1	JENG, SUSY SHU-HSIN MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90691	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
222286	Fee-for-Service	1326240367	1326240367	1	1	JACOBSSON, MARTIN B CRNA	4/26/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
222365	Fee-for-Service	1275551822	1275551822	1	1	JARAHZADEH, MICHAEL R MD	5/4/2007	207R00000X	NA	Other	026	PHYSICIANS	66127	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
222408	Fee-for-Service	1093099046	1093099046	1	2	JUN R. CHIONG, MD, MPH, INC.	7/19/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
222449	Fee-for-Service	1467576751	1467576751	1	1	JOHNS, ALEXIS L PHD	6/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
222456	Fee-for-Service	1104914696	1104914696	1	1	JIMENEZ, CARLOS F MD	2/3/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	577 3RD AVE	None	CHULA VISTA	CA	91910	5619	37	06073	32.63179705	-117.0761336	San Diego County
222627	Fee-for-Service	1396918629	1396918629	1	1	JODHKA, UPINDER K MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110730	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
222629	Fee-for-Service	1407847775	1407847775	1	1	JENG, JAMES C MD	7/28/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172654	None	None	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222652	Fee-for-Service	1275551822	1275551822	1	1	JARAHZADEH, MICHAEL R MD	5/4/2007	207R00000X	NA	Other	026	PHYSICIANS	66127	01	General Practice	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
222663	Fee-for-Service	1467653352	1467653352	1	1	JOURNIGAN, HENRY W CRNA	7/11/2011	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
222697	Fee-for-Service	1093099046	1093099046	1	2	JUN R. CHIONG, MD, MPH, INC.	4/10/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
222904	Fee-for-Service	1609396555	1609396555	1	2	JEBBIA, MALLORY MD	2/18/2024	208600000X	NA	General Surgery	026	PHYSICIANS	157063	None	None	0	In state provider	None	316 S STRATFORD AVE	B	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
222908	Fee-for-Service	1063690238	1063690238	1	1	JENSEN, ROBERT A	7/1/1996	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6001 TELEGRAPH AVE	None	OAKLAND	CA	94609	1310	01	06001	37.84657669	-122.2610501	Alameda County
222915	Fee-for-Service	1396918629	1396918629	1	1	JODHKA, UPINDER K MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110730	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
222940	Fee-for-Service	1174682108	1174682108	1	1	JAMES, JOHN B MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	29752	08	Family Practice	0	In state provider	None	1580 N 2ND ST	None	EL CAJON	CA	92021	3447	37	06073	32.816205	-116.935839	San Diego County
222983	Fee-for-Service	1093099046	1093099046	1	2	JUN R. CHIONG, MD, MPH, INC.	7/16/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
223012	Fee-for-Service	1548300551	1548300551	1	1	JELANI INC	2/3/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1601 QUESADA AVENUE	None	SAN FRANCISCO	CA	94124	2334	38	06075	37.73238125	-122.3898116	San Francisco County
223056	Fee-for-Service	1821101684	1821101684	1	1	JACOBS, MICHAEL E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	573 FIVE CITIES DR	None	PISMO BEACH	CA	93449	3005	40	06079	35.1360133	-120.6229412	San Luis Obispo County
223160	Fee-for-Service	1972681062	1972681062	1	1	JEW, SUSAN YA-PING MD	9/14/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76519	18	Ophthalmology	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
223271	Fee-for-Service	1093099046	1093099046	1	2	JUN R. CHIONG, MD, MPH, INC.	7/8/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
223276	Fee-for-Service	1245872977	1245872977	1	1	JONES, LANDY CRNA	10/21/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
223437	Fee-for-Service	1255332227	1255332227	1	1	JACOBY, ROBERT C MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55944	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
223449	Fee-for-Service	1053486399	1053486399	2	1	JONES, JAMES W MD	10/5/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	37317	45	Nephrology (Renal-Kidney)	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
223465	Fee-for-Service	1598399255	1598399255	1	1	JAWAD PHARMACEUTICAL CORP	7/7/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	307 E 1ST ST	STE D	SANTA ANA	CA	92701	5302	30	06059	33.74557552	-117.864171	Orange County
223491	Fee-for-Service	1053328849	1053328849	1	1	JOHNSON, ORCHID D LMFT	12/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1513 E CHAPMAN AVE	None	FULLERTON	CA	92831	4013	30	06059	33.8741613	-117.9005017	Orange County
223492	Fee-for-Service	1841407665	1841407665	1	85	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	430	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
223505	Fee-for-Service	1982910667	1982910667	1	1	JEFFREY C YOUNG DO INC	7/21/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6648	None	None	0	In state provider	None	416 WEST LAS TUNAS DR	205	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
223595	Fee-for-Service	1316263684	1316263684	1	1	JEFFREY YATES	3/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEDICAL VILLAGE DR	None	EDGEWOOD	KY	41017	3403	00	None	39.01457332	-84.56298791	Kenton County
223735	Fee-for-Service	1528016896	1528016896	1	1	JOHNSON, COLLEEN J MD	4/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91697	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
223737	Fee-for-Service	1053486399	1053486399	2	1	JONES, JAMES W MD	10/5/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	37317	41	Internal Medicine	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
223780	Fee-for-Service	1841407665	1841407665	1	85	JOHN MUIR PHYSICIAN NETWORK	5/1/2023	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	430	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
223789	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RE0101X	NA	Endocrinology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
223793	Fee-for-Service	1215128020	1215128020	1	1	JANUMPALLY, SHIRISHA R	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87490	13	Neurology (M.D. only)	0	In state provider	MD	44902 10TH ST W	None	LANCASTER	CA	93534	2314	19	06037	34.699158	-118.148051	Los Angeles County
223825	Fee-for-Service	1497916498	1497916498	1	1	JOYE, STEVEN M DO	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	4685	55	06109	37.97749352	-120.3700335	Tuolumne County
223833	Fee-for-Service	1346876679	1346876679	1	1	JANI, DHARA LMFT	10/24/2023	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
224005	Fee-for-Service	1427007657	1427007657	1	1	JAHAN, THIERRY M MD	1/31/1993	207RX0202X	NA	Oncology	026	PHYSICIANS	65337	45	Nephrology (Renal-Kidney)	0	In state provider	UCSF MEDICAL CTR #1270	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
224067	Fee-for-Service	1841407665	1841407665	1	85	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	430	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
224076	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
224148	Fee-for-Service	1144246596	1144246596	1	1	JULIAN, VENUS N MD	6/10/1985	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41783	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14673 PARTHENIA STREET	SUITE 102	PANORAMA CITY	CA	91402	2991	19	06037	34.22819333	-118.4523118	Los Angeles County
224163	Fee-for-Service	1245617497	1245617497	1	1	JACOBSON, LAURA A MD	7/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144951	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
224183	Fee-for-Service	1598849218	1598849218	1	1	JENNIFER G. VINCENT MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1401 MADISON ST	STE 100	SEATTLE	WA	98104	1316	00	None	47.61086143	-122.3214551	King County
224356	Fee-for-Service	1841407665	1841407665	1	85	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3100 SAN PABLO AVE	430	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
224364	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RE0101X	NA	Endocrinology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
224413	Fee-for-Service	1790152114	1790152114	2	1	JOANNA J KIM, PHARMACIST INC	12/7/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1750 PACIFIC AVE	STE A	LONG BEACH	CA	90813	1715	19	06037	33.789024	-118.193701	Los Angeles County
224460	Fee-for-Service	1386646404	1386646404	1	1	JAMES CORONA MD	3/19/2003	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	203 WALKER ST	# 2	ORLAND	CA	95963	9904	11	06021	39.74734953	-122.1918345	Glenn County
224532	Fee-for-Service	1518491182	1518491182	1	1	JAMES COOPER	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 SPRINGHILL DR	STE A	N LITTLE ROCK	AR	72117	2922	00	None	34.783704	-92.2230765	Pulaski County
224539	Fee-for-Service	1477078798	1477078798	1	1	JONES-SAAH, MELINDA CNP	2/10/2022	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
224629	Fee-for-Service	1821541764	1821541764	1	1	JANG, MICHAEL J MD	2/23/2024	207R00000X	NA	Other	026	PHYSICIANS	150981	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
224650	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	9/30/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
224654	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
224655	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	9/30/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
224706	Fee-for-Service	1437771094	1437771094	1	1	JIMENEZ GARCIA, LUIS E MD	8/17/2023	163WG0000X	NA	Other	026	PHYSICIANS	183510	None	None	0	In state provider	None	49617 CESAR CHAVEZ ST	SUITE B	COACHELLA	CA	92236	1535	33	06065	33.68797107	-116.1818005	Riverside County
224744	Fee-for-Service	1699119297	1699119297	1	1	JORDAN, JON L OD	2/27/2024	152W00000X	NA	Other	020	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
224747	Fee-for-Service	1255829479	1255829479	1	1	JUNG, HYEYOUNG LCSW	10/5/2024	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
224748	Fee-for-Service	1811032923	1811032923	2	1	JABOUR, ADEL F MD INC	8/1/2011	174400000X	NA	Other	026	PHYSICIANS	30429	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18350 ROSCOE BLVD	STE 200	NORTHRIDGE	CA	91325	4147	19	06037	34.22071855	-118.5341175	Los Angeles County
224749	Fee-for-Service	1386646404	1386646404	1	1	JAMES CORONA MD	12/13/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	203 WALKER ST	# 2	ORLAND	CA	95963	9904	11	06021	39.74734953	-122.1918345	Glenn County
224766	Fee-for-Service	1568857878	1568857878	1	1	JENG, JEFFREY MD	12/26/2019	207L00000X	NA	Other	026	PHYSICIANS	146332	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
224938	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
224942	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RE0101X	NA	Endocrinology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
224943	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	5/3/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
224945	Fee-for-Service	1508807199	1508807199	2	1	JOSEPH, MARY M MD	6/11/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	32726	05	Anesthesiology	0	In state provider	None	235 N HOOVER ST	None	LOS ANGELES	CA	90004	3627	19	06037	34.07580952	-118.283404	Los Angeles County
224985	Fee-for-Service	1194143057	1194143057	1	1	JOHNSON, JENNIFER MD	7/19/2020	2080P0006X	NA	Psychiatry	026	PHYSICIANS	149107	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
225028	Fee-for-Service	1225465271	1225465271	1	1	JUDD PSYCHOLOGICAL SERVICES	11/2/2020	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AND EDUCATION CENTER	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
225033	Fee-for-Service	1811032923	1811032923	2	1	JABOUR, ADEL F MD INC	8/1/2011	174400000X	NA	Other	026	PHYSICIANS	30429	02	General Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 200	NORTHRIDGE	CA	91325	4147	19	06037	34.22071855	-118.5341175	Los Angeles County
225036	Fee-for-Service	1386646404	1386646404	1	1	JAMES CORONA MD	3/19/2003	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	203 WALKER ST	# 2	ORLAND	CA	95963	9904	11	06021	39.74734953	-122.1918345	Glenn County
225059	Fee-for-Service	1184731176	1184731176	1	1	JOHN M. ERICKSON, M.D.	7/18/2015	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
225142	Fee-for-Service	1588279632	1588279632	1	1	JOHNSON, D'ANDRA LMFT	1/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
225228	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QU0200X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
225230	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RE0101X	NA	Endocrinology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
225231	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
225285	Fee-for-Service	1497717813	1497717813	1	1	JUNG, TIMOTHY T MD	12/30/1989	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	52096	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3975 JACKSON ST	STE 202	RIVERSIDE	CA	92503	3947	33	06065	33.92729721	-117.4413503	Riverside County
225306	Fee-for-Service	1376926808	1376926808	1	1	JAMES C. LEE, DPM A PROFESSI	5/19/2019	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ONAL CORP	5475 E LA PALMA AVE	SUITE 208	ANAHEIM	CA	92807	6009	30	06059	33.85997926	-117.7958236	Orange County
225317	Fee-for-Service	1225465271	1225465271	1	1	JUDD PSYCHOLOGICAL SERVICES	11/2/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AND EDUCATION CENTER	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
225323	Fee-for-Service	1811032923	1811032923	2	1	JABOUR, ADEL F MD INC	8/1/2011	174400000X	NA	Other	026	PHYSICIANS	30429	33	Thoracic Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 200	NORTHRIDGE	CA	91325	4147	19	06037	34.22071855	-118.5341175	Los Angeles County
225324	Fee-for-Service	1386646404	1386646404	1	1	JAMES CORONA MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54266	41	Internal Medicine	0	In state provider	None	203 WALKER ST	# 2	ORLAND	CA	95963	9904	11	06021	39.74734953	-122.1918345	Glenn County
225366	Fee-for-Service	1992103220	1992103220	1	1	JONES, RYAN A	9/20/2023	207L00000X	NA	Other	026	PHYSICIANS	166885	None	None	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
225392	Fee-for-Service	1316925787	1316925787	1	1	JOHNSTON, SANTA J MD	4/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
225475	Fee-for-Service	1699919753	1699919753	1	1	JONES, MARIS S MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135639	78	Neoplastic Diseases/Oncology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
225514	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QU0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
225517	Fee-for-Service	1194292359	1194292359	1	1	JIN, MARIA Y NP	11/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
225519	Fee-for-Service	1841407665	1841407665	1	33	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	2305 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
225521	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
225557	Fee-for-Service	1366226995	1366226995	1	1	JOHNSON, RICHARD BIRTH DOUL	5/8/2024	171M00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
225563	Fee-for-Service	1114953841	1114953841	1	1	JU, WERNER W MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42898	07	Dermatology	0	In state provider	None	50 S SAN MATEO DR	STE 430	SAN MATEO	CA	94401	3861	41	06081	37.56634141	-122.3261145	San Mateo County
225564	Fee-for-Service	1568833861	1568833861	1	1	JEW, KENNETH F OD INC	4/29/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	818 JACKSON ST	STE 302	SAN FRANCISCO	CA	94133	4849	38	06075	37.79580797	-122.4086365	San Francisco County
225568	Fee-for-Service	1952641805	1952641805	1	1	JACKSON, NATASHA LCSW	10/16/2024	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
225609	Fee-for-Service	1346219201	1346219201	1	1	JAGWINDER S SRAOW M.D.	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 E SOUTHERN AVE	STE I1	TEMPE	AZ	85282	7738	00	None	33.393357	-111.8821365	Maricopa County
225611	Fee-for-Service	1275772907	1275772907	1	1	JARVIS, JOHN B	3/5/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 4TH STREET	STE 120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
225694	Fee-for-Service	1265116925	1265116925	1	1	JORIL MEDICAL CORP	2/16/2024	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	13622 BEAR VALLEY RD # 1	None	VICTORVILLE	CA	92392	8509	36	06071	34.47041135	-117.3662247	San Bernardino County
225761	Fee-for-Service	1699919753	1699919753	1	1	JONES, MARIS S MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135639	02	General Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
225777	Fee-for-Service	1184057655	1184057655	1	1	JESUS DE SEPE, CLAUDIA F LCS	8/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
225794	Fee-for-Service	1033163092	1033163092	1	1	JACKSON HMA LLC	2/4/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1850 CHADWICK DRIVE	None	JACKSON	MS	39204	3404	00	None	32.28664381	-90.25494911	Hinds County
225801	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
225807	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
225822	Fee-for-Service	1154321123	1154321123	1	1	JERNG, DIANE Y MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63585	08	Family Practice	0	In state provider	None	4200 CHINO HILLS PKWY	# 101	CHINO HILLS	CA	91709	3776	36	06071	33.98274451	-117.7129305	San Bernardino County
225842	Fee-for-Service	1548791056	1548791056	1	1	JONES, JESSICA D MD	2/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157036	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
225966	Fee-for-Service	1114783578	1114783578	1	1	JACKSON, CECELIA LMFT	4/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
225972	Fee-for-Service	1154688810	1154688810	1	1	JEN, MAXWELL Y MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130209	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
225985	Fee-for-Service	1114993177	1114993177	1	1	JAWA, RANDEEP 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	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
226020	Fee-for-Service	1609097542	1609097542	1	1	JONES, GABRIELLA L CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	530 OCEAN ST	STE A	SANTA CRUZ	CA	95060	6628	44	06087	36.97556123	-122.0192565	Santa Cruz County
226039	Fee-for-Service	1194011189	1194011189	1	1	JOHNSON, CECILIA C CRNA	6/29/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	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
226049	Fee-for-Service	1972512432	1972512432	1	1	JOHNSON, DENNIS E MD	6/6/1996	174400000X	NA	Other	026	PHYSICIANS	60358	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1610 S COURT ST	None	VISALIA	CA	93277	4946	54	06107	36.316323	-119.291715	Tulare County
226082	Fee-for-Service	1033163092	1033163092	1	1	JACKSON HMA LLC	2/4/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1850 CHADWICK DRIVE	None	JACKSON	MS	39204	3404	00	None	32.28664381	-90.25494911	Hinds County
226091	Fee-for-Service	1841407665	1841407665	1	20	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	261QU0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
226095	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
226182	Fee-for-Service	1356713135	1356713135	1	1	JMJ CARESERVICES LLC	9/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9127 NORTH BACKER AVE	None	FRESNO	CA	93720	4113	10	06019	36.86873422	-119.7462244	Fresno County
226191	Fee-for-Service	1205903119	1205903119	1	1	JENKINS, TIMOTHY D MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85138	10	Gastroenterology (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
226196	Fee-for-Service	1720474281	1720474281	1	1	JAWAD, SADEED M MD	7/2/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163296	36	Psychiatry	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
226393	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
226394	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QU0200X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
226428	Fee-for-Service	1336112192	1336112192	1	1	JEGRIS, GREGORY 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	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
226468	Fee-for-Service	1639354764	1639354764	1	1	JURICICH, LINDSAY M LCSW	8/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
226568	Fee-for-Service	1124694807	1124694807	1	1	JOSEPH, LEILA DO	2/1/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23591	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
226632	Fee-for-Service	1790776177	1790776177	1	1	JOYFUL ADULT DAY HEALTH	5/17/2001	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	18951 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2981	19	06037	33.98767704	-117.8912613	Los Angeles County
226646	Fee-for-Service	1962508713	1962508713	1	1	JAIN, ANITA MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76657	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
226671	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
226676	Fee-for-Service	1669906830	1669906830	1	1	JARAMILLO-HUFF, ASHLEY MD	7/29/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179338	None	None	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	1689	19	06037	34.15729818	-118.3277073	Los Angeles County
226680	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
226695	Fee-for-Service	1386049260	1386049260	1	1	JAFARI FARSHAMI, FATEMEH MD	7/11/2023	207RR0500X	NA	Other	026	PHYSICIANS	183568	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
226726	Fee-for-Service	1487676821	1487676821	1	1	JOHNSTON,KEVIN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	557 W WASHINGTON	None	BURNS	OR	97720	0000	00	None	43.58870813	-119.060725	Harney County
226757	Fee-for-Service	1669485322	1669485322	1	1	JINDANI, SHILPA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89217	None	None	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
226871	Fee-for-Service	1932159712	1932159712	1	1	JJ&R EMERGENCY MED GRP	8/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
226958	Fee-for-Service	1841407665	1841407665	1	26	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
226971	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
227077	Fee-for-Service	1073679460	1073679460	1	1	JUE, MARY	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
227083	Fee-for-Service	1255485777	1255485777	1	1	JUREK, ANNE C	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2311	41	06081	37.63462925	-122.4259247	San Mateo County
227115	Fee-for-Service	1679536619	1679536619	1	1	JONAS, ADAM J MD	4/24/1995	207SG0201X	NA	Other	026	PHYSICIANS	38801	40	Pediatrics	0	In state provider	None	21840 NORMANDIE AVE	# 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
227168	Fee-for-Service	1932173200	1932173200	1	1	JERAJ DOLENC, TAMARA MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133321	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
227242	Fee-for-Service	1306817903	1306817903	1	1	JAYARAMAN, ARUNA K MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90690	None	None	0	In state provider	None	1210 SONOMA AVE	STE B	SANTA ROSA	CA	95405	6648	49	06097	38.440404	-122.6983185	Sonoma County
227249	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
227257	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
227363	Fee-for-Service	1356799175	1356799175	1	1	JENSEN, KENDAL MD	11/3/2020	207ZP0102X	NA	Other	026	PHYSICIANS	168743	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
227402	Fee-for-Service	1861426629	1861426629	1	1	JOHNSON, RAMON W MD	3/31/1983	207P00000X	NA	Other	026	PHYSICIANS	43212	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
227407	Fee-for-Service	1891879094	1891879094	1	1	JENNIFER PETRIE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1102 E LOCUST ST	None	EMMETT	ID	83617	2713	00	None	43.87907647	-116.4858255	Gem County
227459	Fee-for-Service	1932173200	1932173200	1	1	JERAJ DOLENC, TAMARA MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133321	13	Neurology (M.D. only)	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
227512	Fee-for-Service	1306025341	1306025341	1	1	JUNG, ADAM J MD	5/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107202	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
227534	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	261QU0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
227536	Fee-for-Service	1639254303	1639254303	1	1	JACOBSON, SUSAN J MD	7/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66294	77	Infectious Disease	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
227546	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
227645	Fee-for-Service	1609801562	1609801562	1	1	JOSEPH, TOM MD	7/31/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	73177	30	Radiology	0	In state provider	None	210 S GRAND AVE	STE 124	GLENDORA	CA	91741	4265	19	06037	34.133859	-117.872523	Los Angeles County
227678	Fee-for-Service	1801821376	1801821376	1	5	JOHN MUIR HEALTH	7/1/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
227682	Fee-for-Service	1477640332	1477640332	1	1	JABLON, MARCIA P MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63186	41	Internal Medicine	0	In state provider	None	675 S ARROYO PKWY	None	PASADENA	CA	91105	3263	19	06037	34.13385453	-118.1474229	Los Angeles County
227684	Fee-for-Service	1659878627	1659878627	1	1	JESTILA, TATUM MD	6/12/2024	207R00000X	NA	Other	026	PHYSICIANS	189651	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
227719	Fee-for-Service	1053948877	1053948877	1	1	JREIGE, NINA MD	5/10/2023	208M00000X	NA	Other	026	PHYSICIANS	185762	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
227822	Fee-for-Service	1841407665	1841407665	1	4	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QU0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 130	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
227824	Fee-for-Service	1639254303	1639254303	1	1	JACOBSON, SUSAN J MD	7/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66294	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
227833	Fee-for-Service	1841407665	1841407665	1	14	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3466 MT DIABLO BLVD	STE C-104	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
227862	Fee-for-Service	1275161887	1275161887	1	1	JOSEPH, EVITA MD	9/23/2024	208M00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
227904	Fee-for-Service	1003853227	1003853227	1	1	JOSEPH, SAMUEL G. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	104 W 5TH AVE	STE 400W	SPOKANE	WA	99204	4800	00	None	47.651625	-117.4141485	Spokane County
227937	Fee-for-Service	1992777320	1992777320	1	1	JAYARAM, KIRAN 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	4411 MEDICAL DR	STE 300	SAN ANTONIO	TX	78229	3824	00	None	29.51000304	-98.57210273	Bexar County
227954	Fee-for-Service	1669903175	1669903175	1	1	JUGO, KRISTINE N DO	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	16781	01	General Practice	0	In state provider	None	1570 E HERNDON AVE	None	FRESNO	CA	93720	3303	10	06019	36.83756046	-119.759841	Fresno County
228097	Fee-for-Service	1902061070	1902061070	1	2	JOHN QIAN M.D. INC.	1/4/2023	208VP0014X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	TUTE	5395 RUFFIN ROAD	STE. 204	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
228110	Fee-for-Service	1316560782	1316560782	1	1	JENG, FRANKLIN	9/13/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
228126	Fee-for-Service	1932341500	1932341500	1	1	JUSTIN THOMAS BACA MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
228144	Fee-for-Service	1760790745	1760790745	1	1	JOHANSON, KJERSTI A MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113527	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
228177	Fee-for-Service	1326170838	1326170838	1	1	JONES, MICHELLE S MD	1/12/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81111	40	Pediatrics	0	In state provider	None	5173 LONE TREE WAY	None	ANTIOCH	CA	94531	8689	07	06013	37.96178664	-121.7558046	Contra Costa County
228178	Fee-for-Service	1366804718	1366804718	1	1	JLD THERAPY, PC	5/24/2023	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
228217	Fee-for-Service	1366880395	1366880395	1	1	JANI, ADITI S MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148409	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
228218	Fee-for-Service	1124104054	1124104054	1	1	JOHNSON, GEORGE A MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61753	40	Pediatrics	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
228236	Fee-for-Service	1750583043	1750583043	1	1	JONES, LAUREN E LMFT	10/22/2021	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
228257	Fee-for-Service	1508889007	1508889007	1	1	JONES, MACCAIA D	1/28/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
228324	Fee-for-Service	1437143898	1437143898	1	1	JOSHI, JANARDAN S MD	5/1/1983	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	34855	04	Otology, Laryngology, Rhinology	0	In state provider	None	244 N JACKSON AVE	STE 201	SAN JOSE	CA	95116	1604	43	06085	37.36405837	-121.8488656	Santa Clara County
228338	Fee-for-Service	1356304620	1356304620	1	1	JOHNSON, ALBERT MD	5/31/1987	207P00000X	NA	Other	026	PHYSICIANS	51169	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3030 BUNKER HILL ST	None	SAN DIEGO	CA	92109	5754	37	06073	32.80346216	-117.2151829	San Diego County
228385	Fee-for-Service	1902061070	1902061070	1	2	JOHN QIAN M.D. INC.	10/4/2019	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TUTE	5395 RUFFIN ROAD	STE. 204	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
228422	Fee-for-Service	1982727608	1982727608	1	1	JEWELL, KIM DIANE MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94841	22	Pathology (M.D. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
228446	Fee-for-Service	1619907706	1619907706	1	1	JULIA A PRESCOTT-FOCHT	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1210 W 18TH ST	None	SIOUX FALLS	SD	57104	4647	00	None	43.537329	-96.743223	Minnehaha County
228449	Fee-for-Service	1265553457	1265553457	1	1	JADIA, ROSEMARY R	10/5/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
228468	Fee-for-Service	1366804718	1366804718	1	1	JLD THERAPY, PC	4/25/2022	225X00000X	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
228494	Fee-for-Service	1932401585	1932401585	1	1	JB AND YM INC	11/30/2015	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	17972 SKY PARK CIR	D	IRVINE	CA	92614	4402	30	06059	33.68947173	-117.8600093	Orange County
228525	Fee-for-Service	1144289356	1144289356	1	1	JUHL, GREGORY A MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
228611	Fee-for-Service	1609914688	1609914688	1	1	JONES, CURTIS W NP	5/31/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	308427	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BOULEVARD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
228615	Fee-for-Service	1245448398	1245448398	1	1	JOHNSON, NYSHIA N LCSW	4/2/2020	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NG	14420 CIVIC DRIVE	4	VICTORVILLE	CA	92392	2384	36	06071	34.51268102	-117.3236867	San Bernardino County
228669	Fee-for-Service	1447219902	1447219902	1	1	JELTER, TORIL H MD	2/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50164	40	Pediatrics	0	In state provider	None	3100 TELEGRAPH AVE	FL 2	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
228686	Fee-for-Service	1902977762	1902977762	1	2	JONES, JAMIESON E MD	8/1/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	41922	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
228706	Fee-for-Service	1487631354	1487631354	1	1	JENNIFER LIM-DUNHAM, 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
228754	Fee-for-Service	1366804718	1366804718	1	1	JLD THERAPY, PC	4/25/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
228776	Fee-for-Service	1659399350	1659399350	1	1	JERRY BALDWIN MD	1/27/2016	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
228905	Fee-for-Service	1245448398	1245448398	1	1	JOHNSON, NYSHIA N LCSW	4/2/2020	104100000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NG	14420 CIVIC DRIVE	4	VICTORVILLE	CA	92392	2384	36	06071	34.51268102	-117.3236867	San Bernardino County
228909	Fee-for-Service	1659593556	1659593556	1	1	JEGGE, DAVID MD	10/4/1994	208600000X	NA	General Surgery	026	PHYSICIANS	53860	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
228932	Fee-for-Service	1942326103	1942326103	1	1	JACKSON, THOMAS D CRNA	6/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
228935	Fee-for-Service	1962137299	1962137299	1	1	JAIME, JENNIFER LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1322 E SHAW AVE	SUITE 260	FRESNO	CA	93710	7914	10	06019	36.8087145	-119.7644625	Fresno County
229019	Fee-for-Service	1134661895	1134661895	1	1	JACOBS, LINSEY B MD	9/28/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163571	None	None	0	In state provider	None	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
229046	Fee-for-Service	1770779431	1770779431	1	1	JOG, PRACHI C MD	4/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121507	13	Neurology (M.D. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
229174	Fee-for-Service	1649654005	1649654005	1	1	JONES, ANDREA LMFT	1/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
229185	Fee-for-Service	1043273485	1043273485	1	1	JANAS, JANICE D MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	83486	01	General Practice	0	In state provider	None	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
229224	Fee-for-Service	1982799615	1982799615	1	1	JACKSON, ROBERT M MD	11/30/1986	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	50418	04	Otology, Laryngology, Rhinology	0	In state provider	None	41250 12TH ST W	STE C	PALMDALE	CA	93551	1444	19	06037	34.63265063	-118.1517391	Los Angeles County
229259	Fee-for-Service	1992752059	1992752059	1	1	JURSON, PHILLIP A MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78871	05	Anesthesiology	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
229306	Fee-for-Service	1154597870	1154597870	1	1	JANDA, PAM K MD INC	5/27/2009	193400000X	NA	Other	026	PHYSICIANS	37511	41	Internal Medicine	0	In state provider	None	7078 N MAPLE AVE	SUITE 101	FRESNO	CA	93720	8023	10	06019	36.8385388	-119.7452287	Fresno County
229333	Fee-for-Service	1770779431	1770779431	1	1	JOG, PRACHI C MD	4/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121507	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
229360	Fee-for-Service	1730265976	1730265976	1	1	JEFFREY S CARSTENS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7500 MERCY RD	None	OMAHA	NE	68124	2319	00	None	41.23788049	-96.0306885	Douglas County
229367	Fee-for-Service	1760493126	1760493126	1	1	JUTABHA, CHIAKI M MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64833	49	Unknown	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
229381	Fee-for-Service	1912339029	1912339029	1	1	JEFFERY, MARIA T LCSW	11/8/2019	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
229432	Fee-for-Service	1639102387	1639102387	1	1	JAVAHERI, MANIJEH MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81812	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
229446	Fee-for-Service	1235770165	1235770165	1	1	JOHNSON, P. CURLY CNP	11/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
229474	Fee-for-Service	1003866344	1003866344	1	1	JENSEN, RONALD D DPM	11/1/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1317 OAKDALE RD	STE 100	MODESTO	CA	95355	3362	50	06099	37.662489	-120.957588	Stanislaus County
229505	Fee-for-Service	1972581510	1972581510	1	1	JOHNSON,RODNEY 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	5308 PARKLANE DR	STE 48	KEARNEY	NE	68847	0000	00	None	40.72635	-99.07873701	Buffalo County
229513	Fee-for-Service	1982799615	1982799615	1	1	JACKSON, ROBERT M MD	11/30/1986	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	50418	01	General Practice	0	In state provider	None	41250 12TH ST W	STE C	PALMDALE	CA	93551	1444	19	06037	34.63265063	-118.1517391	Los Angeles County
229515	Fee-for-Service	1093747248	1093747248	1	1	JAIN, VIVEK MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91527	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
229520	Fee-for-Service	1124459532	1124459532	1	1	JACOBY, BRADLEY A DO	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12719	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
229543	Fee-for-Service	1831264092	1831264092	1	1	JHA GERIATRIC SERVICES INC	11/13/2011	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	18855 VICTORY BLVD	None	RESEDA	CA	91335	6444	19	06037	34.18660752	-118.5441525	Los Angeles County
229587	Fee-for-Service	1215318217	1215318217	1	1	JEDRZEJCZYK, ANDY MD	3/13/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
229736	Fee-for-Service	1396893244	1396893244	1	1	JOHNS, BERVIC B JR MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64621	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
229885	Fee-for-Service	1477541001	1477541001	1	1	JULIAN C ZENER MD INC	12/1/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14384	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1430 ESPLANADE	STE 6	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
229941	Fee-for-Service	1417595513	1417595513	1	1	JANETS ENTERPRISE INC	8/12/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7817 SAUTERNE DR	None	RANCHO CUCAMONGA	CA	91730	2410	36	06071	34.11196953	-117.6070613	San Bernardino County
230035	Fee-for-Service	1003389107	1003389107	1	1	JAMES JABER MD A MEDICAL COR	4/22/2021	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NECK SURGERY	850 S ATLANTIC BLVD	305	MONTEREY PARK	CA	91754	6714	19	06037	34.05097684	-118.1379979	Los Angeles County
230065	Fee-for-Service	1811143134	1811143134	1	1	JOHNSON, PATRICIA A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7060 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92111	1003	37	06073	32.83272447	-117.1648125	San Diego County
230088	Fee-for-Service	1659487395	1659487395	1	1	JOHNSON, MATTHEW T MD	1/1/1984	207R00000X	NA	Other	026	PHYSICIANS	38149	41	Internal Medicine	0	In state provider	None	1525 WEBSTER ST	None	FAIRFIELD	CA	94533	4997	48	06095	38.2570563	-122.0475622	Solano County
230146	Fee-for-Service	1063627859	1063627859	1	1	JEFFREY MADSEN M.D.	12/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 W 800 N	None	OREM	UT	84057	3660	00	None	40.31373134	-111.7150045	Utah County
230278	Fee-for-Service	1740332832	1740332832	1	1	JACKSON, ANNE-MARIE MD	2/1/1996	174400000X	NA	Other	026	PHYSICIANS	76326	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1595 SOQUEL DR	STE 220	SANTA CRUZ	CA	95065	1721	44	06087	36.98879599	-121.9826354	Santa Cruz County
230357	Fee-for-Service	1356713135	1356713135	1	2	JMJ CARESERVICES LLC	10/24/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7435 N RIVERSIDE DRIVE	None	FRESNO	CA	93722	9304	10	06019	36.84319938	-119.9109933	Fresno County
230360	Fee-for-Service	1457836744	1457836744	1	1	JASEN, LAURA M LPCC	7/29/2020	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
230416	Fee-for-Service	1285811489	1285811489	1	1	JOHRI, NIDHI MD	4/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102164	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
230431	Fee-for-Service	1144775396	1144775396	1	1	JIAN, STEPHANIE H OD	9/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 MINOR HALL	None	BERKELEY	CA	94720	2020	01	06001	37.87133398	-122.2545466	Alameda County
230447	Fee-for-Service	1407484470	1407484470	1	1	JAFARI, JASMINE MD	6/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178318	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
230458	Fee-for-Service	1922250554	1922250554	1	1	JAVAHERIAN, NEDA PSYD	6/24/2019	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	105749	-	NOT APPLICABLE	0	In state provider	None	4755 AMIGO AVE	None	TARZANA	CA	91356	4501	19	06037	34.15867778	-118.539106	Los Angeles County
230524	Fee-for-Service	1982712790	1982712790	1	1	JONES, KENNETH A JR MD	11/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51261	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
230568	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
230602	Fee-for-Service	1891474904	1891474904	1	2	JOSEPH, JANE	11/16/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95025968	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVENUE	A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
230668	Fee-for-Service	1609895432	1609895432	1	1	JOHNSON, DOUGLAS B	9/17/2003	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2015 S BROADWAY	# B	SANTA MARIA	CA	93454	7809	42	06083	34.92342662	-120.4362114	Santa Barbara County
230725	Fee-for-Service	1275891806	1275891806	1	1	JONES, BENJAMIN D MD	1/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140171	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
230752	Fee-for-Service	1033691928	1033691928	1	1	JOSLIN, MOLLY LCSW	2/10/2025	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
230799	Fee-for-Service	1871675132	1871675132	1	1	JOEL ERIC PITTMAN 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
230802	Fee-for-Service	1124616982	1124616982	1	1	JACOB, JANE LCSW	4/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
230848	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
230869	Fee-for-Service	1538467477	1538467477	1	1	JUAREZ MORALES, LAURIE B MD	1/31/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	121331	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1491	19	06037	34.2395322	-118.3939944	Los Angeles County
230915	Fee-for-Service	1992770804	1992770804	1	1	JAMESON, NANCY A MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63552	None	None	0	In state provider	None	3260 BEARD RD	None	NAPA	CA	94558	3423	28	06055	38.32237321	-122.2955875	Napa County
230981	Fee-for-Service	1205367778	1205367778	1	1	JOSE, JERIN T MD	6/5/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160311	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
230992	Fee-for-Service	1043624588	1043624588	1	1	JIANG, HELEN Y MD	1/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	155172	18	Ophthalmology	0	In state provider	None	4560 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90221	1117	19	06037	34.04057653	-118.167318	Los Angeles County
231080	Fee-for-Service	1508393778	1508393778	1	1	JUAREZ, LETICIA J DPM	8/20/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11332 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3854	36	06071	34.04709935	-117.2436936	San Bernardino County
231089	Fee-for-Service	1245735877	1245735877	1	1	JE, GOUN MD	2/21/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	176502	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
231138	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
231191	Fee-for-Service	1285622175	1285622175	1	1	JACKSON, LEON S MD	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68430	30	Radiology	0	In state provider	None	1800 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
231238	Fee-for-Service	1972593929	1972593929	1	1	JOHN LIN, MD	8/14/2012	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	0000	00	None	33.609294	-112.1797485	Maricopa County
231424	Fee-for-Service	1942797121	1942797121	1	1	JAMBULINGAM, NIKITA N MD	4/8/2022	207RS0012X	NA	Other	026	PHYSICIANS	163520	None	None	0	In state provider	None	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
231427	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
231439	Fee-for-Service	1427505064	1427505064	1	1	JOHNSON, AMY H LCSW	4/19/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100897	-	NOT APPLICABLE	0	In state provider	None	2801 BRISTOL STREET	STE 200	COSTA MESA	CA	92626	5996	30	06059	33.67474907	-117.889122	Orange County
231440	Fee-for-Service	1457976433	1457976433	1	1	JENNIFER S. HUANG, M.D., INC	1/24/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	51 N 5TH AVE	SUITE 303	ARCADIA	CA	91006	3711	19	06037	34.1412293	-118.0205477	Los Angeles County
231449	Fee-for-Service	1396723169	1396723169	1	1	JOHNSON, CHRISANNA L MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	82011	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
231488	Fee-for-Service	1699732008	1699732008	1	1	JONES, STEPHEN E MD	4/30/1987	207P00000X	NA	Other	026	PHYSICIANS	55519	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
231549	Fee-for-Service	1740215219	1740215219	1	1	JOHN MUIR MEDICAL CENTER	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK CAMPUS	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
231566	Fee-for-Service	1891347076	1891347076	1	1	JAEHOON LEE OPTOMETRY CORP	8/20/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	TRY CORP	71956 MAGNESIA FALLS DR	None	RANCHO MIRAGE	CA	92270	4901	33	06065	33.73550164	-116.4089224	Riverside County
231573	Fee-for-Service	1245979889	1245979889	1	1	JONES, KIMBERLY CPO	6/9/2022	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3024 W FLORIDA AVE	None	HEMET	CA	92545	3619	33	06065	33.7474743	-117.0034585	Riverside County
231594	Fee-for-Service	1154139053	1154139053	1	1	JENNIFER STONE, MARRIAGE AND	2/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPY, INC.	5802 ADDAX COURT	None	ROCKLIN	CA	95765	6280	31	06061	38.81554249	-121.2800503	Placer County
231600	Fee-for-Service	1376917047	1376917047	1	1	JOHNSON, ZENA	11/19/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2469 EUREKA DRIVE	None	YUBA CITY	CA	95991	8481	51	06101	39.09334529	-121.6026226	Sutter County
231642	Fee-for-Service	1427228865	1427228865	1	1	JOCSON, JESSICA P MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101446	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
231651	Fee-for-Service	1215531165	1215531165	1	1	JOHNSON, ALLISON CNP	12/6/2021	363L00000X	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
231657	Fee-for-Service	1619017118	1619017118	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	NORTHHAMPTON HOUSE	35284 WILDWOOD CANYON RD	None	YUCAIPA	CA	92399	5115	36	06071	34.01576254	-117.035214	San Bernardino County
231669	Fee-for-Service	1447988019	1447988019	1	3	JULIET DEL PIERO, M.D., INC.	1/19/2023	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	,	80 GARDEN COURT	SUITE 103	MONTEREY	CA	93940	5389	27	06053	36.58531605	-121.8549252	Monterey County
231715	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
231844	Fee-for-Service	1043271463	1043271463	1	1	JEFFREY C. PROUDFOOT, D.O.	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
231884	Fee-for-Service	1356722987	1356722987	1	1	JONES, CASSIE E	1/11/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
231889	Fee-for-Service	1376917047	1376917047	1	1	JOHNSON, ZENA	11/19/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2469 EUREKA DRIVE	None	YUBA CITY	CA	95991	8481	51	06101	39.09334529	-121.6026226	Sutter County
231956	Fee-for-Service	1447988019	1447988019	1	3	JULIET DEL PIERO, M.D., INC.	1/19/2023	261QS0132X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	,	80 GARDEN COURT	SUITE 103	MONTEREY	CA	93940	5389	27	06053	36.58531605	-121.8549252	Monterey County
231996	Fee-for-Service	1255600581	1255600581	1	1	JOHNSON, THERESA C N NP	4/18/2018	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
232000	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
232058	Fee-for-Service	1790082089	1790082089	1	1	JENISA, NUSRAT CHOWDHURY GEN	6/15/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PTR	3720 WEST SIERRA HWY	UNIT G	ACTON	CA	93510	1272	19	06037	34.4931997	-118.1960208	Los Angeles County
232087	Fee-for-Service	1194964387	1194964387	1	1	JONES, JUAN C MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111954	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43830 N 10TH ST WEST	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
232142	Fee-for-Service	1841407665	1841407665	1	88	JOHN MUIR PHYSICIAN NETWORK	7/17/2024	163WG0100X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5801 NORRIS CANYON RD	230	SAN RAMON	CA	94583	5440	07	06013	37.77806921	-121.9581994	Contra Costa County
232152	Fee-for-Service	1033204235	1033204235	1	1	JOEL A. PENGSON, M.D., A MED	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72774	41	Internal Medicine	0	In state provider	ICAL CORPORATION	13050 HEACOCK ST	None	MORENO VALLEY	CA	92553	3122	33	06065	33.931386	-117.243772	Riverside County
232288	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
232316	Fee-for-Service	1033321914	1033321914	1	1	JEFFREY C WAGNER, 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	499 E HAMPDEN AVE	SUITE 360	ENGLEWOOD	CO	80113	3877	00	None	39.65319046	-104.982129	Arapahoe County
232412	Fee-for-Service	1619460490	1619460490	1	1	JORDAN, ADRIAN MD	8/30/2022	208M00000X	NA	Other	026	PHYSICIANS	173441	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
232429	Fee-for-Service	1841407665	1841407665	1	88	JOHN MUIR PHYSICIAN NETWORK	7/17/2024	163WG0100X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	5801 NORRIS CANYON RD	230	SAN RAMON	CA	94583	5440	07	06013	37.77806921	-121.9581994	Contra Costa County
232476	Fee-for-Service	1497183602	1497183602	1	1	JINDAL NEUROLOGY, INC	9/6/2016	2084N0400X	NA	Neurology	026	PHYSICIANS	123212	13	Neurology (M.D. only)	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
232499	Fee-for-Service	1134417843	1134417843	1	1	JENNIFER FELTER	2/20/2024	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	166 S 5TH ST	None	MONTPELIER	ID	83254	4959	00	None	42.31631981	-111.3008075	Bear Lake County
232580	Fee-for-Service	1841407665	1841407665	1	12	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3440 HILLCREST AVE	SUITE 150	ANTIOCH	CA	94531	6369	07	06013	37.98703099	-121.7803342	Contra Costa County
232680	Fee-for-Service	1558139196	1558139196	1	1	JOHNSON, NAOMI LCSW	8/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
232689	Fee-for-Service	1144279951	1144279951	1	1	JAYARAM, ATTIGUPAM R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25987	13	Neurology (M.D. only)	0	In state provider	A PROFESSIONAL CORP	1250 CONCANNON BLVD	None	LIVERMORE	CA	94550	6002	01	06001	37.6609605	-121.7789055	Alameda County
232839	Fee-for-Service	1174726962	1174726962	1	1	JEFFREY ROBERT WAHL, 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	1000 W LINCOLNWAY ST	SUITE WCO	EFFERSON	IA	50129	0000	00	None	42.01528379	-94.38760483	Greene County
232853	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
232904	Fee-for-Service	1518276922	1518276922	1	1	JACOBS, STEVEN J MD INC	6/5/2017	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
233054	Fee-for-Service	1487694931	1487694931	2	1	JAIN, UDAY MD	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	71152	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
233079	Fee-for-Service	1427020254	1427020254	1	1	JOHN C. BRANCATO MD	3/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	282 WASHINGTON ST	None	HARTFORD	CT	06106	3322	00	None	41.75379344	-72.6827855	Capitol Planning Region
233127	Fee-for-Service	1487847448	1487847448	1	1	JOHN PERONA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1202 N MUSKOGEE PL	None	CLAREMORE	OK	74017	3058	00	None	36.322614	-95.60531299	Rogers County
233138	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	1835X0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
233145	Fee-for-Service	1194268029	1194268029	1	2	JARRETT, JESSICA J	9/25/2024	1041C0700X	NA	Mental Health Outpatient Services	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
233154	Fee-for-Service	1952343402	1952343402	1	1	JARED L SZYMANSKI DO PC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 SOUTH OREM BLVD	None	OREM	UT	84058	5011	00	None	40.27974717	-111.6897542	Utah County
233192	Fee-for-Service	1518276922	1518276922	1	1	JACOBS, STEVEN J MD INC	6/5/2017	207R00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	9001 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
233222	Fee-for-Service	1598841694	1598841694	1	1	JOSEPH, BRUCE J MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6001B TRUXTUN AVE	STE 220	BAKERSFIELD	CA	93309	0611	15	06029	35.36254873	-119.0727158	Kern County
233232	Fee-for-Service	1265870075	1265870075	1	1	JANG, CECILIA MD	6/16/2022	207R00000X	NA	Other	026	PHYSICIANS	172876	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
233243	Fee-for-Service	1467741363	1467741363	1	1	JADALLAH, ALI A DO	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14123	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
233275	Fee-for-Service	1578576773	1578576773	1	1	JOHN RAMPTON	7/16/2018	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
233283	Fee-for-Service	1922061423	1922061423	1	1	JINDEEL, AYAD MD	5/1/2001	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	56369	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
233306	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	1/13/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
233323	Fee-for-Service	1245311216	1245311216	1	1	JOHNSON, DANIEL W DO	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9393	08	Family Practice	0	In state provider	None	949 PALM AVE	None	IMPERIAL BEACH	CA	91932	1503	37	06073	32.58380109	-117.1133687	San Diego County
233405	Fee-for-Service	1629144464	1629144464	1	1	JAO, KEDY Y DO AMC	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	4947	08	Family Practice	0	In state provider	None	12675 LA MIRADA BLVD	STE 220	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
233428	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	1835X0200X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
233464	Fee-for-Service	1477095354	1477095354	1	1	JOHNSON, KARRIE	3/31/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
233516	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
233545	Fee-for-Service	1508106584	1508106584	1	1	JAUWENA, MICHELLE H LMFT	1/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
233594	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
233613	Fee-for-Service	1043272099	1043272099	1	1	JAWORSKI,GERALD ANDREW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2282 NW TROOST ST	STE 101	ROSEBURG	OR	97471	0000	00	None	43.234902	-123.385219	Douglas County
233616	Fee-for-Service	1457500779	1457500779	1	1	JAIN, AMITA MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103235	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
233618	Fee-for-Service	1740424043	1740424043	1	1	JIANG, NANCY MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129224	04	Otology, Laryngology, Rhinology	0	In state provider	None	3600 BRODWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
233625	Fee-for-Service	1194786764	1194786764	1	1	JOHNSON, JOHN N MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	10886	10	Gastroenterology (M.D. only)	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
233636	Fee-for-Service	1215027784	1215027784	1	1	JAMES MARSH, MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	None	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
233715	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	1835X0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
233745	Fee-for-Service	1730717935	1730717935	1	1	JIANG, YANTING MD	8/9/2024	207L00000X	NA	Other	026	PHYSICIANS	189362	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
233759	Fee-for-Service	1902984586	1902984586	1	1	JIN, LIN MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88744	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
233805	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	9/20/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
233838	Fee-for-Service	1821059379	1821059379	1	1	JONATHAN W. KERN	2/9/2015	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
233882	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
233904	Fee-for-Service	1427793397	1427793397	1	1	JAMES, JAIVIANA D PT	5/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24021 ALESSANDRO	109-112A	MORENO VALLEY	CA	92553	6707	33	06065	33.9171415	-117.2423475	Riverside County
233905	Fee-for-Service	1740424043	1740424043	1	1	JIANG, NANCY MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129224	84	Surgery-Head and Neck	0	In state provider	None	3600 BRODWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
233913	Fee-for-Service	1194786764	1194786764	1	1	JOHNSON, JOHN N MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	10886	41	Internal Medicine	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
233956	Fee-for-Service	1902216575	1902216575	1	1	JOHNSON, LYDIA M MFT	10/19/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88235	-	NOT APPLICABLE	0	In state provider	None	1322 N AVALON BLVD	None	WILMINGTON	CA	90744	2639	19	06037	33.78953748	-118.263169	Los Angeles County
233997	Fee-for-Service	1831391754	1831391754	1	1	JERICHO, HILARY R MD	1/30/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	183817	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
234001	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	1835X0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
234003	Fee-for-Service	1861748840	1861748840	1	1	JAIN, NIKHIL PSYD	2/28/2020	103T00000X	NA	Mental Health Outpatient Services	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
234094	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
234100	Fee-for-Service	1427042100	1427042100	1	1	JESINGER, ROBERT A MD	2/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87965	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
234112	Fee-for-Service	1508308008	1508308008	1	1	JOHNSON, TASHA	2/10/2025	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
234167	Fee-for-Service	1245569698	1245569698	1	1	JENKINS, VIRGINIA M LMFT	2/11/2020	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
234170	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	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
234204	Fee-for-Service	1083748032	1083748032	1	1	JONES-POLAND, EDITH A MD	4/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76482	01	General Practice	0	In state provider	INC	57475 TWENTY NINE PALMS	STE 101	YUCCA VALLEY	CA	92284	2906	36	06071	34.1245864	-116.4103407	San Bernardino County
234247	Fee-for-Service	1255594818	1255594818	1	1	JAMES, JAISON MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110648	20	Orthopedic Surgery	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
234260	Fee-for-Service	1447577176	1447577176	1	1	JASON R DARRAH MD	8/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1836 SOUTH AVE	None	LA CROSSE	WI	54601	5429	00	None	43.79526216	-91.24709055	La Crosse County
234269	Fee-for-Service	1811940166	1811940166	1	1	JOSHUA KNOWLTON	7/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	560 W 800 N	None	OREM	UT	84057	3746	00	None	40.31214262	-111.7096594	Utah County
234289	Fee-for-Service	1841407665	1841407665	1	74	JOHN MUIR PHYSICIAN NETWORK	10/5/2021	207RH0000X	NA	Hematology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 TAYLOR	103	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
234295	Fee-for-Service	1548295355	1548295355	1	1	JEFFERSON, HURLEY B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	TX COLON & RECTAL SURG	8315 WALNUT LINE LANE,	#220	DALLAS	TX	75231	0000	00	None	32.88342552	-96.761205	Dallas County
234301	Fee-for-Service	1609153402	1609153402	1	1	JAMES BRASWELL ENTERPRISES	10/28/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	32195 AVENUE E	None	YUCAIPA	CA	92399	6203	36	06071	34.02659353	-117.1012005	San Bernardino County
234303	Fee-for-Service	1649225384	1649225384	1	1	JAKOWATZ, JAMES G MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	49811	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
234318	Fee-for-Service	1619075231	1619075231	1	1	JALALI, BEHNAZ MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35317	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
234330	Fee-for-Service	1962446575	1962446575	1	1	JACKSON, JERILYN W MD	1/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67649	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
234363	Fee-for-Service	1811486616	1811486616	1	1	JASON HWANG MD INC	6/11/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
234381	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	9/20/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
234411	Fee-for-Service	1245448398	1245448398	1	2	JOHNSON, NYSHIA N LCSW	4/2/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14420 CIVIC DRIVE	4	VICTORVILLE	CA	92392	2384	36	06071	34.51268102	-117.3236867	San Bernardino County
234416	Fee-for-Service	1215904909	1215904909	1	1	JOSEPH M STILL BURN CENTERS	7/10/2014	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	INC	3675 J DEWEY GRAY CIR	STE 300	AUGUSTA	GA	30909	1868	00	None	33.48795889	-82.09362806	Richmond County
234456	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
234459	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	1/13/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
234469	Fee-for-Service	1699094748	1699094748	1	1	JEREMY FORREST BRUDEVOLD D.O	10/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5225 23RD AVE S	None	FARGO	ND	58107	2168	00	None	46.845468	-96.8753655	Cass County
234546	Fee-for-Service	1992026215	1992026215	1	1	JUMAILY, JEFFREY S MD	11/26/2018	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	147007	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
234574	Fee-for-Service	1427450139	1427450139	1	1	JAIMES, ELSA LCSW	2/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
234596	Fee-for-Service	1689105223	1689105223	1	1	JACKSON, SAMUEL B MD	5/26/2020	207R00000X	NA	Other	026	PHYSICIANS	163124	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
234639	Fee-for-Service	1396873337	1396873337	1	1	JOHNSON, ERICA L LCSW	12/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9245 LAGUNA SPRINGS DR	200	ELK GROVE	CA	95758	7987	34	06067	38.422494	-121.3965495	Sacramento County
234664	Fee-for-Service	1336335355	1336335355	1	1	JEFFREY A KANTOR M.D. A MEDI	6/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	CAL CORPORATION	23206 LYONS AVE	SUITE 110	SANTA CLARITA	CA	91321	2667	19	06037	34.37981956	-118.5384385	Los Angeles County
234671	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
234719	Fee-for-Service	1093328411	1093328411	1	1	JAMGHARTANIAN, MARINA LMFT	4/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	3857 FOOTHILL BLVD	SUITE 19	GLENDALE	CA	91214	1652	19	06037	34.23893612	-118.263699	Los Angeles County
234741	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
234748	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
234884	Fee-for-Service	1336862432	1336862432	1	1	JONES, SHERRY BIRTH DOULA	8/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
234920	Fee-for-Service	1275177388	1275177388	1	1	JONES, ALISON R OT	12/5/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11276 5TH ST	STE 400	RANCHO CUCAMONGA	CA	91730	0921	36	06071	34.0809351	-117.559021	San Bernardino County
234956	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
235033	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
235034	Fee-for-Service	1841407665	1841407665	1	45	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
235183	Fee-for-Service	1659768679	1659768679	1	1	JENNINGS, MILLER DO	8/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20077	30	Radiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
235246	Fee-for-Service	1841407665	1841407665	1	49	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 201	BRENTWOOD	CA	94513	4952	07	06013	37.92519383	-121.734461	Contra Costa County
235321	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	12/7/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
235348	Fee-for-Service	1073968160	1073968160	1	1	JARAMILLO, KITCIA D LMFT	5/2/2022	101YM0800X	NA	Other	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
235396	Fee-for-Service	1801384516	1801384516	1	1	JURIAN, RUZANNA 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
235445	Fee-for-Service	1053353029	1053353029	1	1	JACOBY, RICHARD M MD	3/4/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161416	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
235456	Fee-for-Service	1629538061	1629538061	1	1	JIA, ZHAO LPCC	5/29/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11230 SORRENTO VALLEY RD	STE 220	SAN DIEGO	CA	92121	1300	37	06073	32.90734306	-117.2281918	San Diego County
235477	Fee-for-Service	1245393982	1245393982	2	1	JEOFFREY P BENSON MD INC	7/14/2018	207LP2900X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	OF SANTA BARBARA	504 W PUEBLO ST	SUITE 301	SANTA BARBARA	CA	93105	6211	42	06083	34.42829882	-119.7243868	Santa Barbara County
235580	Fee-for-Service	1871677344	1871677344	2	1	JAMES H WONG OD PROFESSIONAL	10/27/2015	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	1826 BUCHANAN ST	STE A	SAN FRANCISCO	CA	94115	3211	38	06075	37.78696345	-122.4300353	San Francisco County
235594	Fee-for-Service	1942396106	1942396106	1	1	JON P BOHLAND	8/5/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BOYD'S PHARMACY	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
235609	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
235623	Fee-for-Service	1881882256	1881882256	1	1	JOHNSON, OLUWATUMININU A MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128874	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3009	56	06111	34.27623479	-119.2520218	Ventura County
235841	Fee-for-Service	1558317677	1558317677	1	1	JOCHELSON, MAXINE S MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	37530	30	Radiology	0	In state provider	None	18344 CLARK ST	STE 101	TARZANA	CA	91356	3564	19	06037	34.1697537	-118.5323738	Los Angeles County
235876	Fee-for-Service	1881008092	1881008092	1	1	JO, HAESUE LMFT	3/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1071 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	1103	43	06085	37.2509447	-121.8743507	Santa Clara County
235891	Fee-for-Service	1851072334	1851072334	1	1	JOHN G CUMMINGS NP PSYCHIATR	9/28/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	IC NURSING INC	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
235894	Fee-for-Service	1841407665	1841407665	1	57	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 100	BRENTWOOD	CA	94513	4951	07	06013	37.92519383	-121.734461	Contra Costa County
235954	Fee-for-Service	1841845716	1841845716	1	1	JONATHAN PAPPAS MARRIAGE FAM	10/9/2019	103TP2701X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E THOUSAND OAKS BLVD	225	THOUSAND OAKS	CA	91360	8178	56	06111	34.17902886	-118.8749335	Ventura County
235997	Fee-for-Service	1679846547	1679846547	1	2	JON JUSAY ATIGA	3/5/2020	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	25405 HANCOCK AVE.	STE. 108	MURRIETA	CA	92563	5978	33	06065	33.5580833	-117.1850127	Riverside County
236024	Fee-for-Service	1851978712	1851978712	1	1	JOSE, JANINA DO	8/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22905	08	Family Practice	0	In state provider	None	2701 OCEAN PARK BLVD	130	SANTA MONICA	CA	90405	5223	19	06037	34.01830697	-118.4569168	Los Angeles County
236097	Fee-for-Service	1780836080	1780836080	1	1	JA, SYLVIA S OD	8/17/2015	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
236302	Fee-for-Service	1922752971	1922752971	1	1	JANDA, KELLY CCC-SLP	4/17/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
236358	Fee-for-Service	1609931484	1609931484	1	1	JOTHI, SUMAMA MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90856	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVENUE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
236376	Fee-for-Service	1871671636	1871671636	1	1	JENSEN-AKULA, MICHAEL MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	29009	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
236377	Fee-for-Service	1598717845	1598717845	1	1	JULIE M VOSE MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CNT	None	OMAHA	NE	68198	0001	00	None	0	0	None
236476	Fee-for-Service	1003877085	1003877085	1	1	JOHN GILLIAM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PHOENIX PHYSICIAN	4300 W MEMORIAL RD	None	OKLAHOMA	OK	73120	8304	00	None	35.606601	-97.6003605	Oklahoma County
236502	Fee-for-Service	1780791426	1780791426	1	1	JACOBSON, MARK A MD	5/31/1986	207R00000X	NA	Other	026	PHYSICIANS	48654	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
236691	Fee-for-Service	1609844687	1609844687	1	1	JUMPER, JAMES M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52949	01	General Practice	0	In state provider	None	1 DANIEL CT	210-C	SAN FRANCISCO	CA	94109	0000	38	06075	0	0	None
236730	Fee-for-Service	1235354408	1235354408	1	1	JO, WON MD INC	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91260	None	None	0	In state provider	None	10408 INDUSTRIAL CIR	None	REDLANDS	CA	92374	4548	36	06071	34.06469012	-117.2361582	San Bernardino County
236750	Fee-for-Service	1245360114	1245360114	1	1	JAUREGUI, MARICELA LCSW	12/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
236757	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
236804	Fee-for-Service	1497707376	1497707376	1	1	JUNG, ROLAND OD	2/14/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	7TH FLOOR	SAN FRANCISCO	CA	94143	0344	38	06075	37.76344756	-122.4581992	San Francisco County
236880	Fee-for-Service	1871519595	1871519595	1	1	JESSIE HOPKINS HINCHEE	2/23/1984	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	825 N KELLOGG AVE	None	SANTA BARBARA	CA	93111	1119	42	06083	34.45360063	-119.8137179	Santa Barbara County
236984	Fee-for-Service	1487731311	1487731311	1	1	JOSHI, VARSHA V MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70629	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
237032	Fee-for-Service	1447988019	1447988019	1	1	JULIET DEL PIERO, M.D., INC.	1/19/2023	261QS0132X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	,	14 FORD RD	None	CARMEL VALLEY	CA	93924	9511	27	06053	36.48369939	-121.7364881	Monterey County
237043	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
237118	Fee-for-Service	1093755761	1093755761	1	1	JOHNSON, MESHELL D MD	4/1/2000	207RP1001X	NA	Pulmonology	026	PHYSICIANS	84476	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
237130	Fee-for-Service	1073579231	1073579231	1	1	JET, JENNIE MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1595 SOQUEL DRIVE	SUITE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
237135	Fee-for-Service	1194889220	1194889220	1	1	JAMES, BRENDAN R OD	10/21/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	817 COFFEE RD	STE D	MODESTO	CA	95355	4241	50	06099	37.655235	-120.975616	Stanislaus County
237142	Fee-for-Service	1689778029	1689778029	2	1	JURETIC, MARK C MD	11/9/2015	207R00000X	NA	Other	026	PHYSICIANS	51459	41	Internal Medicine	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
237225	Fee-for-Service	1134534571	1134534571	1	1	JAMES, JOJI MD	7/6/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	176909	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
237311	Fee-for-Service	1447988019	1447988019	1	1	JULIET DEL PIERO, M.D., INC.	1/19/2023	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	,	14 FORD RD	None	CARMEL VALLEY	CA	93924	9511	27	06053	36.48369939	-121.7364881	Monterey County
237315	Fee-for-Service	1568572535	1568572535	1	1	JOHNSON, SUSAN E MD	11/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91287	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	254 SANTA FE DR	None	ENCINITAS	CA	92024	5135	37	06073	33.0362673	-117.2869397	San Diego County
237332	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
237343	Fee-for-Service	1518993328	1518993328	1	1	JOHN EDWARD BARBER M.D	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 E SAN ANTONIO ST	STE 501W	VICTORIA	TX	77901	6052	00	None	28.80764696	-96.9981433	Victoria County
237367	Fee-for-Service	1093212508	1093212508	1	1	JORDAN, MICHAEL MD	6/15/2022	207P00000X	NA	Other	026	PHYSICIANS	163806	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
237407	Fee-for-Service	1093755761	1093755761	1	1	JOHNSON, MESHELL D MD	4/1/2000	207RP1001X	NA	Pulmonology	026	PHYSICIANS	84476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
237417	Fee-for-Service	1073579231	1073579231	1	1	JET, JENNIE MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86051	25	Physical Medicine and Rehabilitation	0	In state provider	None	1595 SOQUEL DRIVE	SUITE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
237421	Fee-for-Service	1265425698	1265425698	1	1	JENKINSON,SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV MED ASSOC INC PATHO	75 HOSPITAL DRIVE	STE #370	ATHENS	OH	45701	0000	00	None	39.32736469	-82.11417801	Athens County
237464	Fee-for-Service	1396996252	1396996252	1	1	JUN, ESTHER S MD	7/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103369	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
237489	Fee-for-Service	1588600290	1588600290	1	1	JONES, KIRK DAVID MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60354	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
237572	Fee-for-Service	1659396695	1659396695	1	1	JOSEPH R WATKINS,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N 300 W	STE 404	PROVO	UT	84604	3359	00	None	40.24788856	-111.6640034	Utah County
237603	Fee-for-Service	1568572535	1568572535	1	1	JOHNSON, SUSAN E MD	11/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91287	66	Emergency Medicine (Urgent Care)	0	In state provider	None	254 SANTA FE DR	None	ENCINITAS	CA	92024	5135	37	06073	33.0362673	-117.2869397	San Diego County
237619	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
237652	Fee-for-Service	1598841009	1598841009	1	1	JACOBSEN, BRUCE MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36123	04	Otology, Laryngology, Rhinology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
237735	Fee-for-Service	1083655302	1083655302	1	1	JULIA DUNCAN, F.N.P.	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	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
237763	Fee-for-Service	1073854048	1073854048	1	1	JKL GROUP, INC.	3/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13931 SAN ANTONIO	None	NORWALK	CA	90650	4036	19	06037	33.90466252	-118.0801551	Los Angeles County
237778	Fee-for-Service	1588600290	1588600290	1	1	JONES, KIRK DAVID MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60354	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
237782	Fee-for-Service	1003877077	1003877077	1	1	JACKSON,MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 NORTH MAIN	None	TOOELE	UT	84074	2794	00	None	40.56668579	-112.2959013	Tooele County
237909	Fee-for-Service	1093949687	1093949687	1	1	JOHNSON, ROGER D MD	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107990	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	3075	19	06037	34.06489065	-118.4443287	Los Angeles County
237910	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
237948	Fee-for-Service	1477538700	1477538700	1	1	JULIET, KIRSTEN Q MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67729	None	None	0	In state provider	None	1050 N STATE ST	None	UKIAH	CA	95482	3414	23	06045	39.1623719	-123.2098216	Mendocino County
237991	Fee-for-Service	1336922640	1336922640	1	1	JAMARAI, PREETI CNP	9/28/2023	363L00000X	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
238134	Fee-for-Service	1093779290	1093779290	1	1	JIMINEZ, RONALD W MD	12/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64659	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
238195	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
238207	Fee-for-Service	1760530554	1760530554	1	1	JO, JEFF S MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81480	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
238223	Fee-for-Service	1982167508	1982167508	1	1	JHAVERI, MALHAR A MD	7/13/2022	208M00000X	NA	Other	026	PHYSICIANS	176972	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
238254	Fee-for-Service	1578594206	1578594206	1	1	JOHN TALIEH MEDICAL CORPORA	3/23/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	TION	1401 SPANOS CT	SUITE 203	MODESTO	CA	95355	2810	50	06099	37.66975543	-120.9724048	Stanislaus County
238421	Fee-for-Service	1013478528	1013478528	1	1	JACOB, SHAWN M	5/3/2023	207R00000X	NA	Other	026	PHYSICIANS	179362	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
238447	Fee-for-Service	1205258779	1205258779	1	1	JESSICA ELIZABETH FREEMAN	1/9/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
238483	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
238584	Fee-for-Service	1932387198	1932387198	1	1	JOHN SUTTERLAND MD	7/16/2017	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
238628	Fee-for-Service	1851137780	1851137780	1	1	JONATHAN M FOGEL PHD A PROFE	2/21/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SSIONAL PSYCHOLOGY COR	525 W MAIN ST	SUITE 120	VISALIA	CA	93291	6116	54	06107	36.330003	-119.297439	Tulare County
238637	Fee-for-Service	1578781837	1578781837	1	1	JOSHI, NAMRATA MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102535	08	Family Practice	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
238641	Fee-for-Service	1487689840	1487689840	1	1	JACKSON, JOHN C MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	37527	-	NOT APPLICABLE	0	In state provider	None	256 BUENA VISTA STREET	SUITE 100	GRASS VALLEY	CA	95945	7239	29	06057	39.21442795	-121.0628397	Nevada County
238702	Fee-for-Service	1770525271	1770525271	1	1	JOSHUA ANDREW RAMSEYER M.D.	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
238729	Fee-for-Service	1427255868	1427255868	1	1	JOHNSON, KATHRYN A MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100214	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	M691	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238766	Fee-for-Service	1699779207	1699779207	1	1	JEFFREY C. DAMERON M.D.	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 KANAWHA BLVD E	None	CHARLESTON	WV	25301	2400	00	None	38.34470937	-81.63296112	Kanawha County
238772	Fee-for-Service	1841407665	1841407665	1	46	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	380 CIVIC DR	STE 100	PLEASANT HILL	CA	94523	1946	07	06013	37.96216561	-122.0723497	Contra Costa County
238828	Fee-for-Service	1932287547	1932287547	1	1	JANKU, GEORGE MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	76251	20	Orthopedic Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
238938	Fee-for-Service	1578066908	1578066908	1	1	JESSEY, MONICA LPCC	1/17/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
238985	Fee-for-Service	1629061361	1629061361	1	1	JABER, JAMES F MD	2/11/2014	207L00000X	NA	Other	026	PHYSICIANS	70970	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3587	48	06095	38.26109552	-122.0470245	Solano County
239028	Fee-for-Service	1962665844	1962665844	1	1	JACOBSON, AARON R PHD	1/30/2013	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
239034	Fee-for-Service	1275929895	1275929895	1	1	JAVID, RIHAN DO	5/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16536	36	Psychiatry	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
239136	Fee-for-Service	1467599217	1467599217	1	1	JENKINS, JEFFREY R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49907	02	General Surgery	0	In state provider	None	3257 PROFESSIONAL DR	STE E	AUBURN	CA	95602	2460	31	06061	38.943405	-121.1008195	Placer County
239141	Fee-for-Service	1043300312	1043300312	1	1	JOSHI, PARAMJIT K MD	8/15/2017	2084N0600X	NA	Neurology	026	PHYSICIANS	145988	26	Psychiatry (child)	0	In state provider	None	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
239165	Fee-for-Service	1922204494	1922204494	1	1	JONES, PHILLIP E MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120284	20	Orthopedic Surgery	0	In state provider	None	131 RALEY BLVD	None	CHICO	CA	95928	8347	04	06007	39.7160105	-121.788999	Butte County
239173	Fee-for-Service	1205463049	1205463049	1	1	JENKINS, TEAL MD	7/29/2024	390200000X	NA	Other	026	PHYSICIANS	187545	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
239243	Fee-for-Service	1063402469	1063402469	1	1	JANCATERINO,JON S MD	8/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE EMERGENCY GROUP	1301 PUNCHBOWL STREET	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
239250	Fee-for-Service	1003843087	1003843087	1	1	JANDA, RONALD F OD	5/1/1996	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
239260	Fee-for-Service	1548933286	1548933286	1	1	JONES, KAYLIN D PHD	11/15/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
239304	Fee-for-Service	1912354606	1912354606	1	1	JAIN, NOOPUR MD	10/22/2022	2080P0204X	NA	Other	026	PHYSICIANS	178111	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
239447	Fee-for-Service	1669441127	1669441127	1	1	JANICE SEMEYN D.O.	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 DOCTORS LN	None	CLARION	PA	16214	8513	00	None	41.19015066	-79.39814017	Clarion County
239467	Fee-for-Service	1508023110	1508023110	1	1	JIMENEZ, MELISSA A MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136121	40	Pediatrics	0	In state provider	None	21840 S NORMANDIE AVE	SUITE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
239470	Fee-for-Service	1710506472	1710506472	1	1	JACKSON, SHANNA S NP	12/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10917 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
239473	Fee-for-Service	1740283555	1740283555	1	1	JONES,ANDREW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 LEWISTON ST	None	COTTONWOOD	ID	83522	0000	00	None	46.050417	-116.351646	Idaho County
239567	Fee-for-Service	1801231618	1801231618	1	1	JACKSON, TALITA C LMFT	8/13/2021	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
239582	Fee-for-Service	1285862060	1285862060	1	1	JOHNSON, RANIA M MD	2/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136891	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239613	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
239724	Fee-for-Service	1871665521	1871665521	1	1	JASTI, HYMAVATHY MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74513	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
239800	Fee-for-Service	1942563341	1942563341	1	1	JAWAD, MUHAMMAD U MD	1/19/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171415	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
239833	Fee-for-Service	1073590337	1073590337	1	1	JIM Z. B LU	6/8/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1351 BARCLAY BLVD	None	BUFFALO GROVE	IL	60089	4501	00	None	42.17553	-87.9317685	Lake County
239835	Fee-for-Service	1326232273	1326232273	1	1	JACKSON, KYLIE A PHD	8/1/2013	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
239856	Fee-for-Service	1003312174	1003312174	1	1	JALAN, SOMYA MD	4/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164833	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
239902	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
239935	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
239961	Fee-for-Service	1265796106	1265796106	1	1	JMC PHARMACY INC	8/29/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 W BLAINE STREET	None	RIVERSIDE	CA	92507	3940	33	06065	33.98300746	-117.3282435	Riverside County
239986	Fee-for-Service	1649616137	1649616137	1	1	JIMENEZ, LUIS A PHD	3/30/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
239999	Fee-for-Service	1144470618	1144470618	1	1	JENSEN, KIRSTEN E MD	5/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100156	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
240037	Fee-for-Service	1962691253	1962691253	1	1	JAFARI, BEHROUZ MD	12/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114232	29	Pulmonary Diseases (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
240087	Fee-for-Service	1689891236	1689891236	1	1	JUNG, HEE WOOK CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	18369 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2762	19	06037	33.98851142	-117.9049538	Los Angeles County
240180	Fee-for-Service	1841750494	1841750494	1	1	JELACIC, NICHOLAS P MD	4/25/2023	207P00000X	NA	Other	026	PHYSICIANS	183185	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
240190	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
240222	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
240266	Fee-for-Service	1841432507	1841432507	1	1	JAHROUMI, ALLEN A MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118508	01	General Practice	0	In state provider	None	724 S EL CAMINO REAL	None	SAN CLEMENTE	CA	92672	8009	30	06059	33.42321798	-117.609337	Orange County
240325	Fee-for-Service	1760640692	1760640692	1	1	JASON S. FRISCHER, 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
240326	Fee-for-Service	1962691253	1962691253	1	1	JAFARI, BEHROUZ MD	12/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114232	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
240359	Fee-for-Service	1275018384	1275018384	1	1	JACKSON, KYLE L LMFT	5/29/2020	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
240396	Fee-for-Service	1437800372	1437800372	1	1	JDR FAMILY THERAPY, INC.	3/28/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CES	9135 ARCHIBALD AVE	STE B	RANCHO CUCAMONGA	CA	91730	5227	36	06071	34.08763562	-117.5934458	San Bernardino County
240443	Fee-for-Service	1457570707	1457570707	1	1	JERGE, KARI F MD	12/16/2019	2086S0127X	NA	General Surgery	026	PHYSICIANS	166068	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
240477	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
240512	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
240589	Fee-for-Service	1154592251	1154592251	1	1	JAWADI, SUMAYYA S MD	2/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144628	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
240608	Fee-for-Service	1639190861	1639190861	1	1	JEMELIAN, PAUL JR MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73687	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
240618	Fee-for-Service	1962691253	1962691253	1	1	JAFARI, BEHROUZ MD	12/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114232	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
240683	Fee-for-Service	1932158946	1932158946	1	1	JUDD, TIMOTHY B DO	4/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18577	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
240684	Fee-for-Service	1437800372	1437800372	1	1	JDR FAMILY THERAPY, INC.	3/28/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CES	9135 ARCHIBALD AVE	STE B	RANCHO CUCAMONGA	CA	91730	5227	36	06071	34.08763562	-117.5934458	San Bernardino County
240728	Fee-for-Service	1457570707	1457570707	1	1	JERGE, KARI F MD	12/16/2019	2086S0127X	NA	General Surgery	026	PHYSICIANS	166068	89	Surgery-Traumatic	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240766	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
240799	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
240827	Fee-for-Service	1821072844	1821072844	1	1	JIANG, HUA MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68307	77	Infectious Disease	0	In state provider	None	315 N 3RD AVE	STE 206	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
240834	Fee-for-Service	1508039686	1508039686	1	1	JON HALLSTROM MD	1/13/2016	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
240942	Fee-for-Service	1215985791	1215985791	1	1	JOHNANNING, JASON 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	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
241052	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
241053	Fee-for-Service	1518064807	1518064807	1	1	JAMES, DANIEL W LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36747	-	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
241087	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	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
241130	Fee-for-Service	1588712996	1588712996	1	1	JONES, STANLEY L MD	7/4/1972	No Taxonomy Provided	NA	None	026	PHYSICIANS	21725	20	Orthopedic Surgery	0	In state provider	None	72855 FRED WARING DR	None	PALM DESERT	CA	92260	9367	33	06065	33.72858055	-116.3943135	Riverside County
241166	Fee-for-Service	1205525912	1205525912	1	1	JEREMIC, RYAN W PT	8/4/2023	2251X0800X	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
241167	Fee-for-Service	1033464656	1033464656	1	1	JOHNSON, PAUL M MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127525	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
241261	Fee-for-Service	1992983456	1992983456	1	1	JAGDEO, JARED R MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127647	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
241291	Fee-for-Service	1417103946	1417103946	1	1	JUN, YOUNG MD	3/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109352	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
241341	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
241343	Fee-for-Service	1023038064	1023038064	1	1	JASON HARTIG MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 7TH AVE S	None	BIRMINGHAM	AL	35233	1711	00	None	33.50351519	-86.80482824	Jefferson County
241353	Fee-for-Service	1528096757	1528096757	1	1	JOHNSON, WALTER D MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84949	14	Neurological Surgery	0	In state provider	None	4646 BROCKTON AVE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
241372	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
241455	Fee-for-Service	1033464656	1033464656	1	1	JOHNSON, PAUL M MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127525	01	General Practice	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
241507	Fee-for-Service	1467807289	1467807289	1	1	JIAO, JOCELYN M MD	4/24/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	156028	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241515	Fee-for-Service	1649261413	1649261413	1	1	JOSHI, AARCHAN R MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60513	18	Ophthalmology	0	In state provider	None	520 N PROSPECT AVE	STE 206	REDONDO BEACH	CA	90277	3042	19	06037	33.8529819	-118.3802954	Los Angeles County
241517	Fee-for-Service	1982199592	1982199592	1	1	JACKSON, JOYTONIA DOULA	1/5/2023	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	10	06019	0	0	None
241610	Fee-for-Service	1134420227	1134420227	1	1	JORGENSEN, BENJAMIN D CRNA	12/1/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
241613	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
241629	Fee-for-Service	1841407665	1841407665	1	11	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
241656	Fee-for-Service	1841407665	1841407665	1	89	JOHN MUIR PHYSICIAN NETWORK	4/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 GRANT ST	316	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
241658	Fee-for-Service	1871580407	1871580407	1	1	JAMES M BROOKE	8/12/2018	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
241664	Fee-for-Service	1841407665	1841407665	1	10	JOHN MUIR PHYSICIAN NETWORK	9/30/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
241700	Fee-for-Service	1144549544	1144549544	1	1	JOEL N KNIEP	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
241703	Fee-for-Service	1972658862	1972658862	1	1	JOHNSON, DEBORA L	5/16/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 ALAMEDA ST	None	POMONA	CA	91768	1727	19	06037	34.07825822	-117.7555489	Los Angeles County
241764	Fee-for-Service	1801958251	1801958251	1	1	JUELL SURGICAL ASSOCIATES	6/20/2014	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	None	6554 S MCCARRAN BLVD	STE B	RENO	NV	89509	6149	00	None	39.47663442	-119.7992969	Washoe County
241861	Fee-for-Service	1861789406	1861789406	1	1	JAKIRLIC, NAIDA OD	1/21/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	SUITE 2	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
241879	Fee-for-Service	1740046564	1740046564	1	1	JACKSON, TATIANNA D DOULA	3/20/2024	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	33	06065	0	0	None
241903	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
242083	Fee-for-Service	1669592861	1669592861	1	1	JHA, JANET Y MD	9/15/2010	207L00000X	NA	Other	026	PHYSICIANS	112585	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
242187	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
242200	Fee-for-Service	1558695718	1558695718	1	1	JOHANSEN, IAN T PHD	7/13/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17215 STUDEBAKER RD	SUITE #110	CERRITOS	CA	90703	2548	19	06037	33.874686	-118.0998595	Los Angeles County
242292	Fee-for-Service	1871798132	1871798132	1	1	JASON KANESHIGE M.D.	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 S BERETANIA ST	STE 5	HONOLULU	HI	96813	2414	00	None	21.30610539	-157.8544781	Honolulu County
242305	Fee-for-Service	1457559346	1457559346	1	1	JOEL D ARMITAGE	10/24/2018	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
242358	Fee-for-Service	1720256993	1720256993	1	1	JOHN PREWITT OD INC	10/2/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	943 W GRAND AVE	None	GROVER BEACH	CA	93433	2135	40	06079	35.12152035	-120.6196105	San Luis Obispo County
242430	Fee-for-Service	1447988019	1447988019	1	2	JULIET DEL PIERO, M.D., INC.	1/26/2023	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	,	179 MAIN ST	#2	SOLEDAD	CA	93960	3023	27	06053	36.42773071	-121.3284195	Monterey County
242460	Fee-for-Service	1568704138	1568704138	1	1	JOO, SHARON E MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14649	40	Pediatrics	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
242477	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
242489	Fee-for-Service	1518050137	1518050137	1	1	JACOB, ANNIE M MD	1/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93910	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
242506	Fee-for-Service	1902957772	1902957772	1	1	JANNETTI, ANTHONY F PHD	10/23/2013	No Taxonomy Provided	NA	None	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
242649	Fee-for-Service	1982011060	1982011060	1	1	JEAN, ALDRIDGE G CNP	9/12/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
242654	Fee-for-Service	1043700255	1043700255	1	1	JAVAHERIAN, MILAD MD	8/11/2023	207L00000X	NA	Other	026	PHYSICIANS	174676	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
242718	Fee-for-Service	1447988019	1447988019	1	2	JULIET DEL PIERO, M.D., INC.	1/26/2023	261QS0132X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	,	179 MAIN ST	#2	SOLEDAD	CA	93960	3023	27	06053	36.42773071	-121.3284195	Monterey County
242765	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
242773	Fee-for-Service	1396183919	1396183919	1	1	JOHN M. WARRINGTON, PH.D., P	12/9/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IATES	931 BUENA VISTA ST	STE 307	DUARTE	CA	91010	1724	19	06037	34.141635	-117.9775755	Los Angeles County
242805	Fee-for-Service	1134471964	1134471964	1	1	JENG, JOY S OD	9/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3106 N SAN GABRIEL BLVD	UNIT H	ROSEMEAD	CA	91770	2579	19	06037	34.06493477	-118.0905107	Los Angeles County
242828	Fee-for-Service	1760532634	1760532634	1	1	JOHNSON, CHRISTOPHER S MD	5/4/2015	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
242837	Fee-for-Service	1992808893	1992808893	1	1	JARED M SCOTT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE ROAD	None	MERIDIAN	ID	83702	6351	00	None	43.600527	-116.3518425	Ada County
242843	Fee-for-Service	1932183159	1932183159	1	1	JAVID, ATHIYA D MD	10/3/2005	174400000X	NA	Other	026	PHYSICIANS	44727	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 320	SAN JOSE	CA	95116	1915	43	06085	37.36122014	-121.8505998	Santa Clara County
242887	Fee-for-Service	1144313792	1144313792	1	1	JOHNSON, BRIAN R PHD	5/31/1991	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 W 1ST ST	STE 352	CLAREMONT	CA	91711	4744	19	06037	34.09450024	-117.7183344	Los Angeles County
242929	Fee-for-Service	1114176237	1114176237	1	1	JHA, OM MD	8/12/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	121694	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
242955	Fee-for-Service	1790146819	1790146819	1	1	JAGPAL, TINA S	4/27/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
243022	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	12/13/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
243054	Fee-for-Service	1841407665	1841407665	1	15	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
243117	Fee-for-Service	1194809962	1194809962	1	1	JOHNSON, BARRY K MD	2/8/2015	208VP0000X	NA	Other	026	PHYSICIANS	65572	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
243201	Fee-for-Service	1699321620	1699321620	1	1	JALLOH, ZAINAB D	11/5/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8602 HAYLOFT PLACE	None	RIVERSIDE	CA	92508	7145	33	06065	33.89246953	-117.3275242	Riverside County
243215	Fee-for-Service	1952558181	1952558181	1	1	JONES, JENNIFER J LMFT	6/17/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97584	-	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
243270	Fee-for-Service	1831513225	1831513225	1	1	JIAM, NICOLE MD	8/9/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	160753	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
243294	Fee-for-Service	1508283441	1508283441	1	1	JENNIFER L MROZEK	8/30/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
243311	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RH0003X	NA	Oncology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
243414	Fee-for-Service	1477538114	1477538114	1	1	J&J HEALTH CARE SERVICES	4/23/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GREENHILLS MANOR	238 VIRGINIA AVE	None	CAMPBELL	CA	95008	3908	43	06085	37.28337852	-121.9620964	Santa Clara County
243437	Fee-for-Service	1114370863	1114370863	1	1	JUN XU MD INC	11/13/2017	261QP2300X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	638 W DUARTE RD	SUITE 15	ARCADIA	CA	91007	7616	19	06037	34.12629888	-118.0532077	Los Angeles County
243488	Fee-for-Service	1699321620	1699321620	1	1	JALLOH, ZAINAB D	11/5/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8602 HAYLOFT PLACE	None	RIVERSIDE	CA	92508	7145	33	06065	33.89246953	-117.3275242	Riverside County
243514	Fee-for-Service	1740215219	1740215219	1	5	JOHN MUIR MEDICAL CENTER	7/1/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
243543	Fee-for-Service	1174601967	1174601967	1	1	JUNG, BARBARA L MD	6/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73248	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
243549	Fee-for-Service	1861576316	1861576316	1	1	JEFFREY SCOTT STUART MD INC	6/11/2012	207L00000X	NA	Other	026	PHYSICIANS	69161	None	None	0	In state provider	None	2299 MOWRY AVE	FL 1	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
243573	Fee-for-Service	1649476433	1649476433	1	1	JO, SOLOMON H MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84580	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
243597	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	12/13/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
243631	Fee-for-Service	1932189701	1932189701	1	1	JAMIESON, SHARON S MD	9/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61996	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
243714	Fee-for-Service	1093772592	1093772592	1	1	JAMES CARY WILSON DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST EDWARD MERCY CLINIC	7301 ROGERS AVE	None	FORT SMITH	AR	72903	0000	00	None	35.35551	-94.35276	Sebastian County
243784	Fee-for-Service	1174618474	1174618474	1	1	JASMEET SINGH	3/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
243873	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
243886	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RH0003X	NA	Oncology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
243992	Fee-for-Service	1821272295	1821272295	1	1	JAIRAM, COLIN X MD	10/16/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101534	08	Family Practice	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
244004	Fee-for-Service	1609930189	1609930189	1	1	JANIGIAN, ERIC Y MD	9/20/2007	207L00000X	NA	Other	026	PHYSICIANS	60801	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
244082	Fee-for-Service	1003879826	1003879826	1	1	JULIAN, KATHERINE A MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65109	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
244085	Fee-for-Service	1205120185	1205120185	1	1	JAMIL AHYMED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 HEALTHY WAY	None	OCEANSIDE	NY	11572	1551	00	None	40.651299	-73.63107	Nassau County
244141	Fee-for-Service	1821829771	1821829771	1	1	JONES, JOSHUA PT	8/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1653 N SCHNOOR AVE	107	MADERA	CA	93637	3613	20	06039	36.972837	-120.0844225	Madera County
244147	Fee-for-Service	1639156979	1639156979	1	1	JAIN, INDU MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48352	05	Anesthesiology	0	In state provider	ANTELOPE VALLEY SURGI/CT	44301 N LANCASTER STREET	None	LANCASTER	CA	93534	3700	19	06037	34.696701	-118.1485148	Los Angeles County
244162	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	11/27/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
244175	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
244188	Fee-for-Service	1164917332	1164917332	1	1	JOHNSON, CHRISTOPHER R MD	9/13/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161516	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244210	Fee-for-Service	1720287600	1720287600	1	1	JAREN TATE MARX MD	5/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
244230	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	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
244244	Fee-for-Service	1710968565	1710968565	1	1	JANET CAMPION 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
244342	Fee-for-Service	1023046059	1023046059	1	1	JACOBS, ELIZABETH MD	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
244391	Fee-for-Service	1093864498	1093864498	1	1	JANE LINDSEY LANE MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
244450	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
244463	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RH0003X	NA	Oncology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
244519	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
244547	Fee-for-Service	1891760708	1891760708	1	1	JIGME,SETH 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	3601 FIFTH AVE 4TH FLOOR	4TH FLOOR FALK	PITTSBURGH	PA	15213	0000	00	None	40.44135069	-79.95912416	Allegheny County
244548	Fee-for-Service	1578724977	1578724977	1	1	JEGANATHAN, NIRANJAN MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144063	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
244600	Fee-for-Service	1861719486	1861719486	1	1	JIANG, THOMAS T MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119331	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
244660	Fee-for-Service	1013012566	1013012566	1	1	JIMENEZ, ANGELICA R MD	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93472	08	Family Practice	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
244742	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
244743	Fee-for-Service	1881742799	1881742799	1	1	JENNE, DAVID K DPM	12/21/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
244750	Fee-for-Service	1841407665	1841407665	1	64	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RH0003X	NA	Oncology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 HOSPITAL DRIVE	SUITE 110B	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
244805	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
244837	Fee-for-Service	1578724977	1578724977	1	1	JEGANATHAN, NIRANJAN MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144063	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
244851	Fee-for-Service	1629090709	1629090709	1	1	JORDE, MICHAEL D MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	63898	01	General Practice	0	In state provider	None	2480 SONOMA ST	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
244907	Fee-for-Service	1316554165	1316554165	1	1	JONES, DARRAH W LCSW	4/11/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
244999	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	163WG0100X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
245005	Fee-for-Service	1326185448	1326185448	1	1	JELKS, ANDREA T MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77038	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245029	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
245093	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
245125	Fee-for-Service	1578724977	1578724977	1	1	JEGANATHAN, NIRANJAN MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144063	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
245143	Fee-for-Service	1477529394	1477529394	1	1	JANICE R EKEMO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SWEDISH HOSPITAL MEDIC	500 17TH AVE	None	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
245147	Fee-for-Service	1841407665	1841407665	1	87	JOHN MUIR PHYSICIAN NETWORK	2/12/2024	2279P3800X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	177 LA CASA VIA	STE 200 E	WALNUT CREEK	CA	94598	6101	07	06013	37.91102258	-122.0394478	Contra Costa County
245174	Fee-for-Service	1841407665	1841407665	1	90	JOHN MUIR PHYSICIAN NETWORK	4/7/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	12677 ALCOSTA BLVD	STE 120	SAN RAMON	CA	94583	4423	07	06013	37.77574358	-121.9604905	Contra Costa County
245188	Fee-for-Service	1528128949	1528128949	1	1	JACOB, SAID I MD	4/30/1990	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43666	None	None	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
245249	Fee-for-Service	1134361249	1134361249	1	1	JENNIFER GRIFFITH	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
245287	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	6/12/2020	163WG0100X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
245316	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
245382	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
245435	Fee-for-Service	1841407665	1841407665	1	87	JOHN MUIR PHYSICIAN NETWORK	2/12/2024	2279P3800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	177 LA CASA VIA	STE 200 E	WALNUT CREEK	CA	94598	6101	07	06013	37.91102258	-122.0394478	Contra Costa County
245458	Fee-for-Service	1366281826	1366281826	1	1	JACKSON, JOEL CRNA	9/3/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
245474	Fee-for-Service	1083623193	1083623193	2	1	JASMIN, LUC D MD	2/8/2017	207T00000X	NA	General Surgery	026	PHYSICIANS	51196	14	Neurological Surgery	0	In state provider	None	2121 AIRPARK DR	None	REDDING	CA	96001	2433	45	06089	40.57504478	-122.404802	Shasta County
245530	Fee-for-Service	1407980410	1407980410	1	1	JABER, MOHAMMAD R MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91996	None	None	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
245573	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	163WG0100X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
245603	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
245610	Fee-for-Service	1043847239	1043847239	1	1	JAMES, JAMEZE H MD	10/16/2023	225XP0200X	NA	Other	026	PHYSICIANS	184955	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
245667	Fee-for-Service	1467587196	1467587196	1	1	JENSEN, VIVIAN OD	8/29/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	121 SOUTH DEL MAR AVENUE	STE A	SAN GABRIEL	CA	91776	1345	19	06037	34.102161	-118.0997095	Los Angeles County
245669	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
245711	Fee-for-Service	1588449912	1588449912	1	1	JP MEDICAL TRANSPORT INC.	9/23/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6950 DISTRICT BLVD	None	BAKERSFIELD	CA	93313	2072	15	06029	35.31315589	-119.0801477	Kern County
245765	Fee-for-Service	1659443141	1659443141	1	1	JOY, RICK E DC	2/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1729 TULLY RD	STE 3	MODESTO	CA	95350	4081	50	06099	37.670027	-121.0122656	Stanislaus County
245766	Fee-for-Service	1255544987	1255544987	1	1	JEFFREY SIEGEL, 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	10200 N 92ND ST	STE 150	SCOTTSDALE	AZ	85258	4535	00	None	33.57828	-111.881511	Maricopa County
245820	Fee-for-Service	1750428801	1750428801	1	1	JOSHI, DIVAKAR DO	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9704	03	Allergy	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
245863	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	163WG0100X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
245875	Fee-for-Service	1669433009	1669433009	1	1	JASTI, ANIL K MD	1/22/2018	207RR0500X	NA	Other	026	PHYSICIANS	135254	83	Rheumatology	0	In state provider	None	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
245890	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
245935	Fee-for-Service	1093707788	1093707788	1	2	JUAREZ, MARGARET M MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60420	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1414 E FLORENCE AVE	None	LOS ANGELES	CA	90001	1937	19	06037	33.97471853	-118.249407	Los Angeles County
245945	Fee-for-Service	1497895965	1497895965	1	1	JONBEC CARE, INC	10/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	KENDALL HOUSE	1835 E CITRUS AVE	None	REDLANDS	CA	92374	7603	36	06071	34.05549547	-117.1370205	San Bernardino County
245957	Fee-for-Service	1841407665	1841407665	1	42	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
245988	Fee-for-Service	1104824820	1104824820	1	1	JIVRAJKA, VINOD B MD	10/31/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41517	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	171 W BORT ST	STE 101	LONG BEACH	CA	90805	2111	19	06037	33.87046199	-118.2050591	Los Angeles County
246044	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208600000X	NA	General Surgery	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
246106	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
246150	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	6/12/2020	163WG0100X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
246161	Fee-for-Service	1184123853	1184123853	1	1	JAO, TERRENCE R MD	3/14/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181285	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246169	Fee-for-Service	1245637875	1245637875	1	1	JOHNSON, SAMANTHA	1/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6601 BLUE OAKS BLVD	STE 6103	ROCKLIN	CA	95765	5956	31	06061	38.79835057	-121.2859692	Placer County
246177	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
246271	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
246305	Fee-for-Service	1457331621	1457331621	1	1	JAMES W ROAT	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 HAMILTON BLVD	STE 103	SIOUX CITY	IA	51104	2423	00	None	42.51971402	-96.41760965	Woodbury County
246332	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
246384	Fee-for-Service	1447681432	1447681432	1	1	JAROMAY, MICHELLE J NP	2/17/2022	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
246393	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
246408	Fee-for-Service	1235337486	1235337486	1	1	JAYAKUMAR, PRAVEEN MD	5/1/2014	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
246438	Fee-for-Service	1841407665	1841407665	1	69	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2700 GRANT ST	310	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
246458	Fee-for-Service	1710341037	1710341037	1	1	JANKLY, AIBINA G LMFT	8/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
246466	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
246514	Fee-for-Service	1780693424	1780693424	1	1	JASON M ASHEIM	10/31/2018	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
246558	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
246612	Fee-for-Service	1912300278	1912300278	1	1	JRS MEDICAL CONSULTING, INC.	10/25/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4354 AUBURN BLVD	100	SACRAMENTO	CA	95841	4107	34	06067	38.645883	-121.362228	Sacramento County
246620	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208600000X	NA	General Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
246667	Fee-for-Service	1477537116	1477537116	1	1	JORDAN, KENNETH G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28391	13	Neurology (M.D. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
246671	Fee-for-Service	1043304009	1043304009	1	1	JWCH INSTITUE INC	9/6/2005	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	14371 CLARK AVE	None	BELLFLOWER	CA	90706	2901	19	06037	33.90323754	-118.134141	Los Angeles County
246682	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
246735	Fee-for-Service	1083027445	1083027445	1	1	JARKOWIEC, MARIA MD	12/4/2017	390200000X	NA	Other	026	PHYSICIANS	137707	40	Pediatrics	0	In state provider	None	747 52ND STREET	ROOM 245	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
246756	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
246790	Fee-for-Service	1932603222	1932603222	1	1	JAMES, CHRISTOPHER MD	8/1/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	6600 COYLE AVE	UNIT 1	CARMICHAEL	CA	95608	6344	34	06067	38.667807	-121.310748	Sacramento County
246803	Fee-for-Service	1780842450	1780842450	1	1	JANET H POLLARD MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
246845	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
246906	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	2085R0001X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
246971	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
246990	Fee-for-Service	1851566616	1851566616	1	1	JEFFREY B THOMAS	11/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
247000	Fee-for-Service	1518968536	1518968536	1	1	JING, RAYMOND MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	33230	41	Internal Medicine	0	In state provider	None	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2854	19	06037	33.98885257	-118.3509655	Los Angeles County
247007	Fee-for-Service	1457557126	1457557126	1	1	JUDITH BRANDT DO INC	5/19/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3070 CAMINO HEIGHTS DR	STE B	CAMINO	CA	95709	9508	09	06017	38.73599407	-120.7109181	El Dorado County
247028	Fee-for-Service	1366737728	1366737728	1	1	JOLLEY, BLAIR M DPM	2/5/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
247029	Fee-for-Service	1124133004	1124133004	1	1	JEFFREY M PUGSLEY MD	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
247045	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
247075	Fee-for-Service	1336164185	1336164185	1	1	JOHNSON, CAMERON J MD	5/31/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	70098	36	Psychiatry	0	In state provider	None	11215 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3808	36	06071	34.050438	-117.2436005	San Bernardino County
247136	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	1/30/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
247194	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	10/11/2021	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
247199	Fee-for-Service	1780782854	1780782854	1	1	JOHNS, MICHAEL M MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137438	04	Otology, Laryngology, Rhinology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
247258	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
247294	Fee-for-Service	1457557126	1457557126	1	1	JUDITH BRANDT DO INC	8/17/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3070 CAMINO HEIGHTS DR	STE B	CAMINO	CA	95709	9508	09	06017	38.73599407	-120.7109181	El Dorado County
247320	Fee-for-Service	1811195092	1811195092	1	1	JAYARAMAN, VIJAY MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
247334	Fee-for-Service	1841407665	1841407665	1	7	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5565 LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
247414	Fee-for-Service	1376603399	1376603399	1	1	JAFFEE, IAN M MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93612	22	Pathology (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
247426	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
247470	Fee-for-Service	1184685489	1184685489	1	1	JAGODOWICZ, MORRIS MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34110	05	Anesthesiology	0	In state provider	None	2829 W BURBANK BLVD	None	BURBANK	CA	91505	2300	19	06037	34.17733959	-118.3423681	Los Angeles County
247479	Fee-for-Service	1770825457	1770825457	1	1	JAZBEH, SAMMER MD	7/23/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161902	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
247483	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
247484	Fee-for-Service	1588906879	1588906879	1	1	JARDOSH, KUNAL R MD	7/22/2020	207L00000X	NA	Other	026	PHYSICIANS	151123	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
247547	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
247584	Fee-for-Service	1457557126	1457557126	1	1	JUDITH BRANDT DO INC	8/17/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3070 CAMINO HEIGHTS DR	STE B	CAMINO	CA	95709	9508	09	06017	38.73599407	-120.7109181	El Dorado County
247607	Fee-for-Service	1811195092	1811195092	1	1	JAYARAMAN, VIJAY MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	1707 W CHARLESTON BLVD	230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
247618	Fee-for-Service	1841407665	1841407665	1	56	JOHN MUIR PHYSICIAN NETWORK	11/27/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1455 MONTEGO	STE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
247708	Fee-for-Service	1841407665	1841407665	1	52	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD RD	SUITE 100	ORINDA	CA	94563	3042	07	06013	37.87712752	-122.1816965	Contra Costa County
247757	Fee-for-Service	1700229689	1700229689	1	1	JIMENEZ, ERIKA R	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133841	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
247766	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	2085R0001X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
247835	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
247902	Fee-for-Service	1699176305	1699176305	1	1	JOHNSON, MIRNA LMFT	3/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	141 N ARROWHEAD AVE	SUITE 5	SAN BERNARDINO	CA	92408	1016	36	06071	34.101522	-117.289612	San Bernardino County
247932	Fee-for-Service	1942838891	1942838891	1	1	JOUHARIAN, PEDRAM MD	8/11/2023	207R00000X	NA	Other	026	PHYSICIANS	185306	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
247960	Fee-for-Service	1538211859	1538211859	1	1	JAMES L KIMBALL III MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
248045	Fee-for-Service	1083177331	1083177331	1	1	JIN, YURI MD	7/29/2022	207P00000X	NA	Other	026	PHYSICIANS	176541	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
248058	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	208600000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
248079	Fee-for-Service	1740281765	1740281765	1	2	JEANETTE SHELLY	12/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25431 CABOT RD	STE 118	LAGUNA HILLS	CA	92653	5527	30	06059	33.59115448	-117.6744575	Orange County
248101	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
248122	Fee-for-Service	1841407665	1841407665	1	39	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 140	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
248178	Fee-for-Service	1427086206	1427086206	1	1	JOHN JEFFREY ALEXANDER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1900	00	None	41.46242416	-81.69888235	Cuyahoga County
248296	Fee-for-Service	1902487382	1902487382	1	1	JONES, SHAUNPAUL MD	10/9/2024	390200000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	19	06037	34.18784988	-118.6427021	Los Angeles County
248333	Fee-for-Service	1053766493	1053766493	1	1	JACOB R ADAMS DO INC	3/2/2020	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
248345	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	9/28/2022	2085R0001X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
248354	Fee-for-Service	1275385866	1275385866	1	1	JENSEN-CODY, SHARON BIRTH D	5/3/2024	251E00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
248391	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
248546	Fee-for-Service	1801445929	1801445929	1	1	JULIET ACOLATSE	6/20/2020	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES, LP	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
248586	Fee-for-Service	1902487382	1902487382	1	1	JONES, SHAUNPAUL MD	10/9/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	19	06037	34.18784988	-118.6427021	Los Angeles County
248604	Fee-for-Service	1477902476	1477902476	1	1	JANUS COUNSELING CENTER A	10/20/2017	193400000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MARRIAGE AND FAMILY	301 E CARRILLO STREET	STE A	SANTA BARBARA	CA	93101	1410	42	06083	34.42479033	-119.6983878	Santa Barbara County
248624	Fee-for-Service	1972815637	1972815637	1	1	JAUREGUI, TONETTE M LMFT	11/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5033 ARLINGTON AVE	A	RIVERSIDE	CA	92504	3812	33	06065	33.94613546	-117.4128435	Riverside County
248636	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
248677	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208D00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
248680	Fee-for-Service	1750337531	1750337531	1	1	JESER, MARC D DO	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
248700	Fee-for-Service	1043365794	1043365794	1	1	JAMIL, LAITH H MD	10/21/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52686	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
248743	Fee-for-Service	1548348279	1548348279	1	1	JAN, BRIAN ARTHUR MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77653	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
248748	Fee-for-Service	1922728286	1922728286	1	1	JORGENSEN, AUBREY J NP	2/2/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9508 STOCKDALE HWY	SUITE 150	BAKERSFIELD	CA	93311	3622	15	06029	35.35453237	-119.1086014	Kern County
248769	Fee-for-Service	1528548641	1528548641	1	1	JIANG, SIRU LAC	9/26/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
248821	Fee-for-Service	1235399908	1235399908	1	1	JUSTIN,PATTEE 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	333 NORTH SMITH AVE	None	ST PAUL	MN	55102	2344	00	None	44.94251219	-93.1074995	Ramsey County
248836	Fee-for-Service	1801445929	1801445929	1	1	JULIET ACOLATSE	6/20/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES, LP	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
248842	Fee-for-Service	1528300787	1528300787	1	1	JENKINS, ANN L MD	1/25/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
248852	Fee-for-Service	1316340227	1316340227	1	1	JEFFERSON HEALTHCARE LLC	12/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	635 SOUTH MAGNOLIA AVE	None	EL CAJON	CA	92020	6012	37	06073	32.788683	-116.962304	San Diego County
248862	Fee-for-Service	1891474904	1891474904	1	1	JOSEPH, JANE NP	10/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
248917	Fee-for-Service	1972995280	1972995280	1	1	JACK, JEREMIAH L CRNA	12/19/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
248921	Fee-for-Service	1841407665	1841407665	1	75	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208600000X	NA	General Surgery	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	130 LA CASA	3-211	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
248923	Fee-for-Service	1265572143	1265572143	1	1	JACKSON, EMILY J MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115194	41	Internal Medicine	0	In state provider	None	372 ARDEN AVE	STE 200	GLENDALE	CA	91203	1129	19	06037	34.1584394	-118.261212	Los Angeles County
248927	Fee-for-Service	1114337854	1114337854	1	1	JONES, ALDRIC M N MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144992	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
248965	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	6/24/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
248988	Fee-for-Service	1043365794	1043365794	1	1	JAMIL, LAITH H MD	10/21/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52686	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
249060	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
249079	Fee-for-Service	1225108475	1225108475	1	1	JENNINGS, HENRY CPO	6/16/2021	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	10683 MAGNOLIA AVE	SUITE A	RIVERSIDE	CA	92505	1893	33	06065	33.90827892	-117.4680748	Riverside County
249154	Fee-for-Service	1427287580	1427287580	1	1	JAWAD, SAWSAN MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148732	08	Family Practice	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
249166	Fee-for-Service	1811422314	1811422314	1	1	JEANLUS, ASHLEY MD	7/6/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173191	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
249171	Fee-for-Service	1023714573	1023714573	1	1	JOURNEY MEDICAL TRANSPORTATI	4/17/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON, LLC	8977 FOOTHILL BLVD	UNIT D	RANCHO CUCAMONGA	CA	91730	3498	36	06071	34.10653001	-117.6091175	San Bernardino County
249207	Fee-for-Service	1023070059	1023070059	1	1	JENKINS, CURBY D DO	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12028	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
249209	Fee-for-Service	1841407665	1841407665	1	79	JOHN MUIR PHYSICIAN NETWORK	10/4/2021	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	400 TAYLOR	101	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
249241	Fee-for-Service	1417366584	1417366584	1	1	JOHNSTON, WILLIAM F MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138944	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
249256	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
249347	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	12/14/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
249383	Fee-for-Service	1164518098	1164518098	1	1	JOKERST ELIZABETH S MD	5/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75002	08	Family Practice	0	In state provider	None	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	01	06001	37.54845774	-121.9773463	Alameda County
249452	Fee-for-Service	1467835595	1467835595	1	1	JANO, ENI MD	7/29/2021	390200000X	NA	Other	026	PHYSICIANS	173137	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
249475	Fee-for-Service	1518349737	1518349737	1	1	JOHL, RANDEEP S MD	7/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153197	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
249480	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
249542	Fee-for-Service	1841407665	1841407665	1	73	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
249565	Fee-for-Service	1417994476	1417994476	1	1	JOHN P KOVALCHIN MD	4/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
249596	Fee-for-Service	1336436039	1336436039	1	1	JUENGER, KENNETH T MD	10/29/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	136161	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
249628	Fee-for-Service	1134504780	1134504780	1	1	JHAJ, GURDEEP S MD	6/21/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161860	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
249632	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	12/14/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
249745	Fee-for-Service	1487188728	1487188728	1	1	JOSHI, ISHITA DO	10/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15060	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
249748	Fee-for-Service	1447456918	1447456918	1	1	JOUNG, KEONG M MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92831	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
249767	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
249798	Fee-for-Service	1508153875	1508153875	1	1	JING, KAI MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128431	None	None	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
249884	Fee-for-Service	1336436039	1336436039	1	1	JUENGER, KENNETH T MD	10/29/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	136161	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
249923	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
249934	Fee-for-Service	1558712182	1558712182	1	1	JEAN, ELIE MD	6/24/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168259	None	None	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
249962	Fee-for-Service	1073622452	1073622452	1	1	JAMES CROSBY,DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9141 GRANT ST	STE 237	THORNTON	CO	80229	4318	00	None	39.86385504	-104.983935	Adams County
249986	Fee-for-Service	1295927911	1295927911	1	1	JAIN, VIPUL V MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88214	41	Internal Medicine	0	In state provider	None	445 SOUTH CEDAR AVENUE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
250026	Fee-for-Service	1316363476	1316363476	1	1	JORDAN, LORRAINE O MD	3/31/2020	261QU0200X	NA	Other	026	PHYSICIANS	84617	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
250036	Fee-for-Service	1447456918	1447456918	1	1	JOUNG, KEONG M MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92831	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
250054	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
250081	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	7/27/2020	261QP2000X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250083	Fee-for-Service	1942964895	1942964895	1	1	JOYCE, KELLY NP	5/8/2023	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
250137	Fee-for-Service	1982135323	1982135323	1	1	JANICZEK, DAVID M MD	7/1/2022	207L00000X	NA	Other	026	PHYSICIANS	176105	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
250181	Fee-for-Service	1205175106	1205175106	1	1	JAMES, JUDY L W LCSW	6/26/2017	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
250210	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
250294	Fee-for-Service	1538184171	1538184171	1	1	JONES, DEBORAH L NP	7/31/2020	363LN0000X	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
250326	Fee-for-Service	1407639131	1407639131	1	1	JIMENEZ, SABRINA A BIRTH DOU	9/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
250342	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
250360	Fee-for-Service	1518972884	1518972884	1	1	JENNIFER	3/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
250367	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	261QP2000X	NA	Physical Therapist	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250445	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
250477	Fee-for-Service	1497287890	1497287890	1	1	JARAMILLO, JULIANA MD	8/12/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172114	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
250479	Fee-for-Service	1346585270	1346585270	1	1	JOHNSON, ASHLEIGH E LCSW	1/14/2020	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
250498	Fee-for-Service	1841407665	1841407665	1	1	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5860 OWENS DR	None	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
250618	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250630	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
250638	Fee-for-Service	1982083960	1982083960	1	1	JENNY ZHAO	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 MALCOM X BLVD	None	NEW YORK	NY	10037	1802	00	None	40.81447535	-73.94040027	New York County
250654	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	1/21/2020	261QP2000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250655	Fee-for-Service	1104274596	1104274596	1	1	JWCH INSTITUTE, INC	7/14/2017	261QC1500X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	15898 W GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1432	19	06037	34.01001897	-117.9604613	Los Angeles County
250683	Fee-for-Service	1598928822	1598928822	1	1	JAHANGIRI, SAMIRA C MD	12/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114291	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
250686	Fee-for-Service	1083837512	1083837512	1	1	JOHN C FREMONT HLTHCARE	1/1/1989	282NC0060X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT DP/SNF	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
250724	Fee-for-Service	1396371431	1396371431	1	1	JONES, CHRISTA E NP	12/1/2020	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
250733	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
250813	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
250898	Fee-for-Service	1376962266	1376962266	1	1	JIA, XIAOLIN MD	2/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137670	41	Internal Medicine	0	In state provider	None	300 PASTEUR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250906	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250918	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
250943	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QP2000X	NA	Physical Therapist	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
250944	Fee-for-Service	1104274596	1104274596	1	1	JWCH INSTITUTE, INC	7/14/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	15898 W GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1432	19	06037	34.01001897	-117.9604613	Los Angeles County
251011	Fee-for-Service	1689991317	1689991317	1	1	JOHNSON, KATHERINE H	12/24/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5225 CANYON CREST DR	STE 13	RIVERSIDE	CA	92507	6301	33	06065	33.95618617	-117.3293404	Riverside County
251021	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
251071	Fee-for-Service	1043256167	1043256167	1	1	JOHN R COLLOP, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7300 N CANTON CENTER RD	None	CANTON	MI	48187	1579	00	None	42.33737438	-83.48864684	Wayne County
251101	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
251141	Fee-for-Service	1265807622	1265807622	1	1	JOHNSON, MEGAN MD	2/12/2018	207P00000X	NA	Other	026	PHYSICIANS	139564	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
251196	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	3/11/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251207	Fee-for-Service	1841407665	1841407665	1	40	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 130	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
251234	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	1/21/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251284	Fee-for-Service	1073542924	1073542924	1	1	JETTON, NORMAN B MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	20703	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
251308	Fee-for-Service	1578005138	1578005138	1	1	JEW, KELLI N NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251310	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
251366	Fee-for-Service	1235198441	1235198441	1	1	JONNALA, ANILA MD	9/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76658	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
251390	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	1/1/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
251445	Fee-for-Service	1447889217	1447889217	1	1	JU, DIANE MD	8/6/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251452	Fee-for-Service	1750565644	1750565644	1	1	JOSEPH WHEELER	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
251480	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251518	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251543	Fee-for-Service	1801277751	1801277751	1	1	JUDGE, SEAN MD	8/21/2024	390200000X	NA	Other	026	PHYSICIANS	145320	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
251596	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
251653	Fee-for-Service	1083107197	1083107197	1	1	JOHNSON, LESLIE A MD	9/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174743	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
251666	Fee-for-Service	1881033397	1881033397	1	1	JONES, BRADLEY	6/9/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1183 E FOOTHILL BLVD	None	UPLAND	CA	91786	9999	36	06071	34.10724648	-117.6359175	San Bernardino County
251677	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
251770	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251807	Fee-for-Service	1841407665	1841407665	1	67	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QP2000X	NA	Physical Therapist	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
251830	Fee-for-Service	1629396353	1629396353	1	1	JRP MEDICAL GROUP INC	6/22/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	9670 MAGNOLIA AVE	201	RIVERSIDE	CA	92503	3654	33	06065	33.91860995	-117.4494692	Riverside County
251847	Fee-for-Service	1386606804	1386606804	1	1	JEIVEN, SUSAN D MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54202	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
251883	Fee-for-Service	1639222672	1639222672	1	1	JAIN, ASHIKA M MD	3/12/2025	207P00000X	NA	Other	026	PHYSICIANS	None	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
251884	Fee-for-Service	1841407665	1841407665	1	28	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2301 CAMINO RAMON	STE 110	SAN RAMON	CA	94583	2029	07	06013	37.77574883	-121.9663326	Contra Costa County
251902	Fee-for-Service	1154986339	1154986339	1	1	JOHNS, PRADEEP R MD	7/17/2023	207P00000X	NA	Other	026	PHYSICIANS	20910	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
251913	Fee-for-Service	1063695799	1063695799	1	1	JINADU, LAIDE A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91917	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
251946	Fee-for-Service	1295729119	1295729119	1	1	JAIN, RITU MD	5/31/1987	207L00000X	NA	Other	026	PHYSICIANS	50419	05	Anesthesiology	0	In state provider	CASE MED. GRP.	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
251966	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
252059	Fee-for-Service	1841407665	1841407665	1	23	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	STE 285	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
252117	Fee-for-Service	1629396353	1629396353	1	1	JRP MEDICAL GROUP INC	6/22/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9670 MAGNOLIA AVE	201	RIVERSIDE	CA	92503	3654	33	06065	33.91860995	-117.4494692	Riverside County
252142	Fee-for-Service	1558450445	1558450445	1	1	JIAN TONG, 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 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
252149	Fee-for-Service	1548925522	1548925522	1	1	JURADO, ALYSSA LCSW	2/7/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
252156	Fee-for-Service	1255448197	1255448197	1	1	JURA, MARTHA B PHD	12/11/2002	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
252253	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	1/1/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
252345	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	6/12/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
252398	Fee-for-Service	1750470720	1750470720	1	1	JANET PHARM ENTERP, INC	10/1/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4300 ROSE DRIVE	SUITE D	YORBA LINDA	CA	92886	2128	30	06059	33.89815111	-117.8419708	Orange County
252437	Fee-for-Service	1245406024	1245406024	1	2	JOSEPH NASSIR MD INC	5/7/2019	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	IANS	17822 BEACH BLVD	430	HUNTINGTON BEACH	CA	92647	7102	30	06059	33.70331388	-117.9890471	Orange County
252461	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QR0200X	NA	Mammography/MRI Provider	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
252515	Fee-for-Service	1194349837	1194349837	1	1	JAFFE, LINDSEY M LCSW	6/14/2023	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
252518	Fee-for-Service	1134417447	1134417447	1	1	JOHANSSON, MELANIE D MD	5/8/2023	208VP0000X	NA	Other	026	PHYSICIANS	183026	None	None	0	In state provider	None	3434 VILLA LANE	STE 150	NAPA	CA	94558	6405	28	06055	38.32515937	-122.2938358	Napa County
252543	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
252550	Fee-for-Service	1255675351	1255675351	1	1	JACKSON, KAREEM I LMFT	11/27/2019	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
252633	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
252699	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
252724	Fee-for-Service	1285760637	1285760637	1	1	JOHNSON, GREGORY LMFT	3/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 LIME ST	BUILDING 2/SUITE 103	RIVERSIDE	CA	92501	2971	33	06065	33.98276147	-117.3693188	Riverside County
252752	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QR0200X	NA	Mammography/MRI Provider	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
252771	Fee-for-Service	1114018199	1114018199	1	1	JAN, RONALD G MD INC	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	22975	02	General Surgery	0	In state provider	None	5025 J ST	STE 312	SACRAMENTO	CA	95819	3839	34	06067	38.566773	-121.441851	Sacramento County
252830	Fee-for-Service	1841407665	1841407665	1	48	JOHN MUIR PHYSICIAN NETWORK	1/1/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	4000 DUBLIN BLVD	SUITE 305	DUBLIN	CA	94568	3121	01	06001	37.70553949	-121.872609	Alameda County
252884	Fee-for-Service	1497955132	1497955132	2	1	JESUS LUA M.D A PROFESSIONAL	3/19/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	360 E 7TH STREET	A	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
252922	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	9/30/2019	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
252987	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
253000	Fee-for-Service	1699235325	1699235325	1	1	JOSE, MARISSA CNP	9/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	626 MAIN	None	DELANO	CA	93215	2934	15	06029	35.76497762	-119.2446332	Kern County
253041	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	261QR0200X	NA	Mammography/MRI Provider	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
253056	Fee-for-Service	1538246194	1538246194	1	1	JONES, ANTHONY E	3/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64757	None	None	0	In state provider	None	400 29TH ST	STE 501	OAKLAND	CA	94609	1234	01	06001	37.81784861	-122.2652263	Alameda County
253117	Fee-for-Service	1902085822	1902085822	1	1	JORDAN, SARA M MD	5/6/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	101266	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
253154	Fee-for-Service	1699000976	1699000976	1	1	JOLLY, YEN P 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
253165	Fee-for-Service	1023428828	1023428828	1	1	JOHNSON, REBECCA L MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120607	22	Pathology (M.D. only)	0	In state provider	None	183 E 8TH AVENUE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
253207	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
253238	Fee-for-Service	1215909577	1215909577	1	1	JOHNSTON, MICHAEL W CRNA	9/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
253243	Fee-for-Service	1063571628	1063571628	1	1	JOHNA, SAMIR D MD	2/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	52638	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
253276	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
253286	Fee-for-Service	1104967892	1104967892	1	1	JUDY, HERBERT P MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37931	25	Physical Medicine and Rehabilitation	0	In state provider	None	961 N RICE AVE	STE 3	OXNARD	CA	93030	8900	56	06111	34.21032488	-119.1422566	Ventura County
253325	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	2/1/2019	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
253342	Fee-for-Service	1245368109	1245368109	1	1	JEONG, MATTHEW C MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87010	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
253366	Fee-for-Service	1023436417	1023436417	1	1	JOSHUA, JISHA K MD	6/18/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	144956	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
253403	Fee-for-Service	1760464945	1760464945	1	1	JOAD, JESSE P	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42593	40	Pediatrics	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
253466	Fee-for-Service	1811121429	1811121429	1	1	JAGHAB, LAURIE PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
253478	Fee-for-Service	1215510524	1215510524	1	1	JRBR, INC.	6/28/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	990 SONOMA AVE	STE 19	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
253496	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
253526	Fee-for-Service	1235692724	1235692724	1	1	JU, CONNIE MD	3/21/2024	390200000X	NA	Other	026	PHYSICIANS	181839	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
253564	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
253616	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
253648	Fee-for-Service	1447817721	1447817721	1	1	JAEWOOD HEALTHCARE LLC	6/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	435 E GLADSTONE ST	None	GLENDORA	CA	91740	5159	19	06037	34.11396648	-117.8564895	Los Angeles County
253680	Fee-for-Service	1487184339	1487184339	1	1	JOHNSON, CHELSEA I LMFT	7/1/2019	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
253749	Fee-for-Service	1770865115	1770865115	1	1	JONES, NATHAN CRNA	11/6/2019	367500000X	NA	Other	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
253750	Fee-for-Service	1619053790	1619053790	1	1	JUSTUS, KEVIN R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79053	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3751 S HARVARD BLVD	None	LOS ANGELES	CA	90018	4546	19	06037	34.019217	-118.306196	Los Angeles County
253784	Fee-for-Service	1841407665	1841407665	1	59	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
253833	Fee-for-Service	1275582660	1275582660	1	1	JOYCE, BEVERLY MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48760	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
253853	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
253863	Fee-for-Service	1720114598	1720114598	1	1	JACOBSON, PAUL A MD	1/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35556	08	Family Practice	0	In state provider	None	1300 KURT DR	STE 104	ANGELS CAMP	CA	95222	1048	05	06009	38.07476917	-120.5364629	Calaveras County
253903	Fee-for-Service	1093807448	1093807448	1	1	JONES, RICHARD D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30296	40	Pediatrics	0	In state provider	None	3520 E SHIELDS AVE	STE 101	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
253904	Fee-for-Service	1841407665	1841407665	1	66	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	261QR0200X	NA	Mammography/MRI Provider	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3000 OAK RD	STE 111	WALNUT CREEK	CA	94597	2004	07	06013	37.929699	-122.0581615	Contra Costa County
253926	Fee-for-Service	1902029424	1902029424	1	1	JOHN C FREMONT HLTHCARE	12/1/1977	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL ROAD	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
253935	Fee-for-Service	1023552973	1023552973	1	1	JACKSON, AYSIA LMFT	1/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	122	TEMECULA	CA	92590	4857	33	06065	33.52030169	-117.1659061	Riverside County
253943	Fee-for-Service	1649442070	1649442070	1	1	JOHN P FANTAUZZI MD	1/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
253948	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
253970	Fee-for-Service	1134395585	1134395585	1	1	JOYCE, ROBERT J OD APC	9/28/2007	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	32245 MISSION TRAIL	STE D4	LAKE ELSINORE	CA	92530	4528	33	06065	33.65526061	-117.2976756	Riverside County
254088	Fee-for-Service	1043312200	1043312200	1	1	JANIUK,DONALD J OD	3/26/2001	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12845 POWAY RD	STE 209	POWAY	CA	92064	4527	37	06073	32.95652195	-117.0520277	San Diego County
254095	Fee-for-Service	1891558086	1891558086	1	1	JAGER, HANNA NP	3/22/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
254141	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
254149	Fee-for-Service	1508060757	1508060757	1	1	JOFFRION, HEIDI G LMFT	9/11/2018	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
254186	Fee-for-Service	1063562239	1063562239	1	1	JAVAHERY, RAMIN J MD	8/7/2011	207T00000X	NA	General Surgery	026	PHYSICIANS	68653	14	Neurological Surgery	0	In state provider	ASSOCIATES	2888 LONG BEACH BLVD	STE 240	LONG BEACH	CA	90806	1570	19	06037	33.809706	-118.189343	Los Angeles County
254235	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
254281	Fee-for-Service	1447244090	1447244090	1	1	JOEBCHEN, NEIL R MD	2/22/1982	207P00000X	NA	Other	026	PHYSICIANS	22046	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
254300	Fee-for-Service	1881765584	1881765584	1	1	JOHNSON, THOMAS L JR	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41044	34	Urology and Urological Surgery	0	In state provider	None	9100 S SEPULVEDA BLVD	SUITE 121	LOS ANGELES	CA	90045	4849	19	06037	33.954147	-118.396111	Los Angeles County
254304	Fee-for-Service	1730189937	1730189937	1	1	J R MEDICAL, INC	8/1/1993	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	18003 SKY PARK CIR	STE H	IRVINE	CA	92614	6536	30	06059	33.68831508	-117.8580054	Orange County
254370	Fee-for-Service	1013356567	1013356567	1	1	JAHANSHAHI, POOYA MD	2/13/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	148363	07	Dermatology	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
254375	Fee-for-Service	1649636432	1649636432	1	1	JOLLY, CATHERINE LMFT	11/22/2024	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
254392	Fee-for-Service	1407956816	1407956816	1	1	JARRAHY, REZA MD	8/1/1998	208200000X	NA	General Surgery	026	PHYSICIANS	66518	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
254408	Fee-for-Service	1740767201	1740767201	1	1	JITOSHO, MICHAEL S OD	7/22/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 BUTTE ST	None	REDDING	CA	96001	0827	45	06089	40.58587336	-122.3848508	Shasta County
254429	Fee-for-Service	1841407665	1841407665	1	34	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
254453	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
254472	Fee-for-Service	1457125627	1457125627	1	1	JOHNSON, TYRESHA POSTPARTUM	1/16/2024	172V00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
254524	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
254526	Fee-for-Service	1407142896	1407142896	1	1	JACKSON, DEDE C F NP	4/5/2018	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
254535	Fee-for-Service	1518180298	1518180298	1	1	JARIANGPRASERT, SUCHAT	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38158	02	General Surgery	0	In state provider	MD INC	2936 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
254542	Fee-for-Service	1326434200	1326434200	1	1	JOHNSON, SHEEVA MD	9/24/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	147946	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
254562	Fee-for-Service	1093938516	1093938516	1	1	JOHN C FREMONT HLTHCARE	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	DISTRICT HOSPICE	5108 HIGHWAY 140	STE C	MARIPOSA	CA	95338	9208	22	06043	37.48928689	-119.9700043	Mariposa County
254569	Fee-for-Service	1962425892	1962425892	1	1	JONES, ROBERT K MD	5/6/1990	207L00000X	NA	Other	026	PHYSICIANS	54785	05	Anesthesiology	0	In state provider	None	10572 CALLE LEE	STE 122	LOS ALAMITOS	CA	90720	8528	30	06059	33.80890075	-118.0573006	Orange County
254584	Fee-for-Service	1689939118	1689939118	1	1	JONATHON G ANDERSON M.D.	1/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
254637	Fee-for-Service	1699260216	1699260216	1	1	JUNG, CHAN MD	8/10/2022	207L00000X	NA	Other	026	PHYSICIANS	165145	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
254646	Fee-for-Service	1083838411	1083838411	1	1	JOSHUA DEERE MD	4/26/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 S COLUMBIA RD	None	GRAND FORKS	ND	58201	4059	00	None	47.907828	-97.06647697	Grand Forks County
254660	Fee-for-Service	1467474650	1467474650	1	1	JACOBSON, JOHN D MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	27047	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
254688	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
254699	Fee-for-Service	1689017840	1689017840	1	1	JANDALI, RAMZY MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135981	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
254716	Fee-for-Service	1275682635	1275682635	1	1	JANAKES, JOSEPH J CRNA	2/14/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
254741	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
254744	Fee-for-Service	1801885884	1801885884	1	1	JOHN MICHAEL NEIL, MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9003 E SHEA BLVD	None	SCOTTSDALE	AZ	85260	6709	00	None	33.580377	-111.88548	Maricopa County
254746	Fee-for-Service	1013462654	1013462654	1	1	JENKINS, VUTHY S NP	4/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	665838	-	NOT APPLICABLE	0	In state provider	None	3703 SUNSET LANE	None	ANTIOCH	CA	94509	6101	07	06013	37.98484278	-121.8041945	Contra Costa County
254750	Fee-for-Service	1942204490	1942204490	1	1	JAMES D TATE MD	4/9/1992	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	PATIENTS HOSP OF REDDING	2900 EUREKA WAY	None	REDDING	CA	96001	0220	45	06089	40.58549966	-122.4167649	Shasta County
254761	Fee-for-Service	1255718144	1255718144	1	1	JOHNSON, CIARA MD	11/29/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	162497	None	None	0	In state provider	None	355 DARDANELLI LANE	None	LOS GATOS	CA	95032	1438	43	06085	37.262493	-121.967456	Santa Clara County
254815	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
254824	Fee-for-Service	1518180298	1518180298	1	1	JARIANGPRASERT, SUCHAT	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38158	01	General Practice	0	In state provider	MD INC	2936 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
254841	Fee-for-Service	1326006966	1326006966	1	3	JULES STEIN EYE INSTITUTE ME	6/28/2019	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DICAL GROUP	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
254851	Fee-for-Service	1093938516	1093938516	1	1	JOHN C FREMONT HLTHCARE	5/8/2024	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT HOSPICE	5108 HIGHWAY 140	STE C	MARIPOSA	CA	95338	9208	22	06043	37.48928689	-119.9700043	Mariposa County
254904	Fee-for-Service	1659676187	1659676187	1	1	JORDAN, JAIME M MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116408	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
254935	Fee-for-Service	1700317740	1700317740	1	1	JAGODA, KAYLA S MD	11/25/2020	207P00000X	NA	Other	026	PHYSICIANS	162382	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
254950	Fee-for-Service	1396239745	1396239745	1	1	JANG, SOO J AU	10/11/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
254960	Fee-for-Service	1447493143	1447493143	1	1	JOHNSON, JENNIFER A MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127981	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254964	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
254973	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	7/28/2020	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255029	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
255076	Fee-for-Service	1235700022	1235700022	1	1	JAMEEL, IHAB MD	11/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
255085	Fee-for-Service	1881628352	1881628352	1	1	JOHNSON, J PATRICK MD	4/30/1991	207T00000X	NA	General Surgery	026	PHYSICIANS	61860	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
255101	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
255104	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
255227	Fee-for-Service	1841201605	1841201605	1	1	JOHN D OLSON, M.D.	5/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
255244	Fee-for-Service	1033473806	1033473806	1	1	JEYASINGH, DINAH L MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128517	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
255255	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
255263	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255317	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255344	Fee-for-Service	1508150590	1508150590	1	1	JO, DANIEL H S MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147880	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
255347	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
255357	Fee-for-Service	1083363980	1083363980	1	1	JUNG, SORI NP	12/16/2024	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
255388	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
255392	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
255475	Fee-for-Service	1306866207	1306866207	1	1	JAIN, ANKUR MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85135	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
255538	Fee-for-Service	1992768626	1992768626	1	1	JOGLAR, JEANNE 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	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
255539	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
255550	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255580	Fee-for-Service	1235289042	1235289042	1	1	JORDAN, THOMAS H DPM	9/9/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
255590	Fee-for-Service	1134182744	1134182744	1	1	JOO, MIHAE G MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78309	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
255605	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	10/24/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
255629	Fee-for-Service	1629117890	1629117890	1	1	JONATHAN ROSS FISH MD	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
255640	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
255675	Fee-for-Service	1841407665	1841407665	1	27	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4165 BLACKHAWK PLAZA CIR	STE 265	DANVILLE	CA	94506	4691	07	06013	37.79914917	-121.9171295	Contra Costa County
255678	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
255681	Fee-for-Service	1588291827	1588291827	1	1	JI, SAMUEL S DO	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	20488	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
255692	Fee-for-Service	1174548945	1174548945	1	1	JONES, SAMUEL MD	6/16/2023	207P00000X	NA	Other	026	PHYSICIANS	66965	None	None	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
255719	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
255749	Fee-for-Service	1780613828	1780613828	1	1	JURKIEWICZ, LAURIE D CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
255825	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
255837	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255842	Fee-for-Service	1306380092	1306380092	1	1	JOHN W. KOETT, M.D., PHD, IN	9/6/2017	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	C.	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
255847	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
255893	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
255911	Fee-for-Service	1811906316	1811906316	1	1	JACKSON, AMANDA S MD	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91439	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
255928	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
255963	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
255967	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
256008	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
256047	Fee-for-Service	1952725145	1952725145	1	1	JAIN, SNEHA S MD	7/5/2024	207R00000X	NA	Other	026	PHYSICIANS	173765	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
256052	Fee-for-Service	1033190780	1033190780	1	1	JOEL T LITTLES, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 MEDICAL PKWY	STE 570	AUSTIN	TX	78705	1024	00	None	30.30500791	-97.74430984	Travis County
256100	Fee-for-Service	1689661167	1689661167	1	1	JOYCE, RICHARD G	1/31/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	258 SUNSET AVE	STE F	SUISUN CITY	CA	94585	1769	48	06095	38.24534869	-122.0204874	Solano County
256114	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
256126	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
256133	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
256182	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	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
256212	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	9/30/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
256254	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
256255	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
256291	Fee-for-Service	1487959938	1487959938	1	1	JOHN TRACY CLINIC	3/28/2017	252Y00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 E WARDLOW RD	None	LONG BEACH	CA	90807	4626	19	06037	33.81887954	-118.183059	Los Angeles County
256296	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
256317	Fee-for-Service	1124156617	1124156617	1	1	JUAREZ, LOURDES NP	7/15/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
256336	Fee-for-Service	1952725145	1952725145	1	1	JAIN, SNEHA S MD	7/5/2024	207R00000X	NA	Other	026	PHYSICIANS	173765	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
256405	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
256413	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
256422	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
256460	Fee-for-Service	1518255215	1518255215	1	1	JANI, SANKET M MD FAAP	7/1/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	9363	10	06019	36.7423511	-119.7834688	Fresno County
256470	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	2/18/2020	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
256503	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	8/30/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
256519	Fee-for-Service	1811956758	1811956758	1	1	JACOBS, STEVEN R MD	1/1/1982	207ZC0500X	NA	Other	026	PHYSICIANS	38027	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
256542	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
256544	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
256556	Fee-for-Service	1073531802	1073531802	1	1	JUTZY, KENNETH R MD	11/30/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37876	None	None	0	In state provider	None	11234 ANDERSON ST	BLDG 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
256578	Fee-for-Service	1609933381	1609933381	1	1	JONES, CHRISTOPHER	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
256582	Fee-for-Service	1487959938	1487959938	1	1	JOHN TRACY CLINIC	11/18/2013	252Y00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 E WARDLOW RD	None	LONG BEACH	CA	90807	4626	19	06037	33.81887954	-118.183059	Los Angeles County
256584	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	6/19/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
256594	Fee-for-Service	1831107762	1831107762	1	1	JA, STEVEN K OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2180 TULLY RD	None	SAN JOSE	CA	95122	1345	43	06085	37.32736338	-121.8182396	Santa Clara County
256597	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
256626	Fee-for-Service	1932154788	1932154788	1	2	J ROBERT WEST, M.D., INC	5/14/2023	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
256648	Fee-for-Service	1851783690	1851783690	1	1	JACKSON, LINDSEY J LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106199	-	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
256691	Fee-for-Service	1841407665	1841407665	1	9	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5820 STONERIDGE MALL RD	STE 101	PLEASANTON	CA	94588	3275	01	06001	37.69432028	-121.9316867	Alameda County
256697	Fee-for-Service	1851928832	1851928832	1	1	JOUDEH, AMMAR MD	10/16/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185068	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
256702	Fee-for-Service	1841407665	1841407665	1	37	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
256708	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
256755	Fee-for-Service	1326518325	1326518325	1	1	JOHNSTON, KAREN R MD	8/26/2022	207ZP0102X	NA	Other	026	PHYSICIANS	67445	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
256756	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	10/24/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
256787	Fee-for-Service	1841407665	1841407665	1	55	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	140 BROOKWOOD ROAD	STE 200	ORINDA	CA	94563	3044	07	06013	37.87712752	-122.1816965	Contra Costa County
256830	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
256831	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
256872	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
256882	Fee-for-Service	1386792026	1386792026	1	1	JAMES, CATHERINE T MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83141	08	Family Practice	0	In state provider	None	10520 MACARTHUR BLVD	None	OAKLAND	CA	94605	5248	01	06001	37.74310419	-122.152591	Alameda County
256886	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
256890	Fee-for-Service	1417024357	1417024357	1	1	JOE, HARRY N MD	7/1/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38602	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
256917	Fee-for-Service	1932154788	1932154788	1	2	J ROBERT WEST, M.D., INC	5/14/2023	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
256934	Fee-for-Service	1841279841	1841279841	1	1	JIANG, KENNETH P MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66628	41	Internal Medicine	0	In state provider	None	901 SUNSET DR	STE 2	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
256947	Fee-for-Service	1932318938	1932318938	1	1	JONES, SHARON A LMFT	9/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2111 O ST	None	MERCED	CA	95334	1409	24	06047	37.30735677	-120.4854711	Merced County
256968	Fee-for-Service	1225165053	1225165053	1	1	JAN & GAILS CARE HOMES INC	7/26/2001	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	605 S ARONIAN ST	None	TULARE	CA	93274	8250	54	06107	36.20373437	-119.3176561	Tulare County
256999	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
257045	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	10/24/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
257115	Fee-for-Service	1396420493	1396420493	1	1	JULIE S ZHANG EAST BAY HOSPI	7/3/2023	208M00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	TALIST	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
257116	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
257118	Fee-for-Service	1841407665	1841407665	1	16	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	401 GREGORY LN	STE 104	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
257160	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	7/5/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
257170	Fee-for-Service	1164440731	1164440731	1	1	JULIE A MARSH	10/31/2018	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
257174	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
257176	Fee-for-Service	1881128221	1881128221	1	1	JENSEN, JASON MD	11/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	188806	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
257224	Fee-for-Service	1467615104	1467615104	1	1	JANISIEWICZ, AGNIESZKA M MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108890	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
257289	Fee-for-Service	1841407665	1841407665	1	30	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 200	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
257333	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
257388	Fee-for-Service	1417915430	1417915430	1	1	JUSTIN A LAMB D.O.	1/2/2014	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
257391	Fee-for-Service	1528202272	1528202272	1	1	JONES, DEREK B MD	8/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107403	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92307	1027	37	06073	32.89687721	-117.2418677	San Diego County
257404	Fee-for-Service	1598942781	1598942781	1	1	JOHNSON, ROBERT R MD	12/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121032	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
257405	Fee-for-Service	1841407665	1841407665	1	21	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
257441	Fee-for-Service	1083691182	1083691182	1	1	JOHNSON, RICHARD G MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45973	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
257448	Fee-for-Service	1841407665	1841407665	1	58	JOHN MUIR PHYSICIAN NETWORK	6/19/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
257459	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
257483	Fee-for-Service	1265517072	1265517072	2	1	JOHNSON, MEGAN D MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84685	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
257621	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
257692	Fee-for-Service	1598942781	1598942781	1	1	JOHNSON, ROBERT R MD	12/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121032	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
257749	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	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
257772	Fee-for-Service	1679006324	1679006324	1	1	JANDAY, NAVJOT K NP	2/26/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	729 N MEDICAL CTR DR W	STE 223	CLOVIS	CA	93611	6879	10	06019	36.84152435	-119.6624818	Fresno County
257794	Fee-for-Service	1073541199	1073541199	1	1	JAHED, IDA MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54746	30	Radiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95430	2149	49	06097	38.471625	-122.7259935	Sonoma County
257822	Fee-for-Service	1982932182	1982932182	1	1	JAJODIA, ARCHANA PHD	8/1/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4445 EASTGATE MALL	STE 200	SAN DIEGO	CA	92121	1979	37	06073	32.87856225	-117.2103399	San Diego County
257876	Fee-for-Service	1083763353	1083763353	1	1	JOHNSON, SCOTT R MD	6/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	47719	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
257889	Fee-for-Service	1316907298	1316907298	1	1	JACKSON, JASON T MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55638	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
257898	Fee-for-Service	1871872309	1871872309	1	1	JAFARI, LIDA MD	3/8/2019	2085B0100X	NA	MRI Provider	026	PHYSICIANS	132217	30	Radiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
257908	Fee-for-Service	1841407665	1841407665	1	41	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	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
257923	Fee-for-Service	1902395775	1902395775	1	1	JAVAHERIAN, JEIRAN DO	1/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19160	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
257926	Fee-for-Service	1821201807	1821201807	1	1	JOSEPHS, KAREN LMFT	8/25/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
257940	Fee-for-Service	1245641935	1245641935	1	1	JOHNSON, ERIK L DO	9/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14580	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
257951	Fee-for-Service	1720026925	1720026925	1	1	JUSTER, JEANETTE 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	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
257956	Fee-for-Service	1891744728	1891744728	1	1	JJ & R EMERGENCY MED GRP	4/27/2006	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA, INC	15248 ELEVENTH STREET	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
258037	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
258093	Fee-for-Service	1154648285	1154648285	1	1	JENKINS, GERARD P MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120341	41	Internal Medicine	0	In state provider	None	3687 MT. DIABLO BLVD	#200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
258128	Fee-for-Service	1659455624	1659455624	1	1	JOSEPH, MATTHEW N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66520	08	Family Practice	0	In state provider	None	6010 COMMERCE BLVD	STE 141	ROHNERT PARK	CA	94928	2127	49	06097	38.35214355	-122.7105663	Sonoma County
258197	Fee-for-Service	1841407665	1841407665	1	47	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 PORTER DRIVE	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
258326	Fee-for-Service	1841407665	1841407665	1	44	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	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
258329	Fee-for-Service	1427293836	1427293836	1	1	JEFFERY, JASON R MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106462	41	Internal Medicine	0	In state provider	None	751 SOUTH BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
258345	Fee-for-Service	1871568444	1871568444	2	1	JETER, JOANNE M MD	10/13/2023	207RX0202X	NA	Oncology	026	PHYSICIANS	191393	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
258359	Fee-for-Service	1639391527	1639391527	1	1	JOSIE M. NISNISAN, M.D.	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12121 RICHMOND AVE	STE 120	HOUSTON	TX	77082	2420	00	None	29.73055208	-95.59325785	Harris County
258377	Fee-for-Service	1164044640	1164044640	1	1	JAFARVAND GIGLOU, MAHBOD MD	9/6/2024	390200000X	NA	Other	026	PHYSICIANS	188021	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
258385	Fee-for-Service	1871645846	1871645846	1	1	JONES, THOMAS R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	47037	36	Psychiatry	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
258416	Fee-for-Service	1659455624	1659455624	1	1	JOSEPH, MATTHEW N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66520	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6010 COMMERCE BLVD	STE 141	ROHNERT PARK	CA	94928	2127	49	06097	38.35214355	-122.7105663	Sonoma County
258530	Fee-for-Service	1073739058	1073739058	1	1	JORGE ALBERTO PINEDA, 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	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
258585	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	1/7/2021	208D00000X	NA	Adult Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
258609	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RH0003X	NA	Oncology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
258658	Fee-for-Service	1750818175	1750818175	1	1	JEFFREY R HODGSON MD CORPORA	7/23/2020	207LP2900X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	TION	348 IRIS	None	SALINAS	CA	93906	3514	27	06053	36.69347517	-121.6574161	Monterey County
258662	Fee-for-Service	1316148778	1316148778	1	1	JOE-MATSUO, BRENDA C LMFT	9/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	405 PRIMROSE RD	#307	BURLINGAME	CA	94010	4043	41	06081	37.57898499	-122.3495049	San Mateo County
258667	Fee-for-Service	1144488198	1144488198	1	1	JESS, HEIDI A MD	10/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105674	22	Pathology (M.D. only)	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
258743	Fee-for-Service	1134234875	1134234875	1	1	JIFFRY, NIN Y MD	1/16/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43827	40	Pediatrics	0	In state provider	None	7223 CHURCH AVE	STE C1	HIGHLAND	CA	92346	0000	36	06071	34.12267372	-117.2043678	San Bernardino County
258750	Fee-for-Service	1316987217	1316987217	1	1	JOHN RYAN GALLAGHER MD	8/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3216 N MAIN ST	None	ALTUS	OK	73521	1307	00	None	34.67187062	-99.33405929	Jackson County
258759	Fee-for-Service	1053590505	1053590505	1	1	JAYASEKERA, NEIL S MD	6/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	54573	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
258772	Fee-for-Service	1871207282	1871207282	1	1	JONES, MARQUITA D	5/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
258853	Fee-for-Service	1942551049	1942551049	1	1	JAZAYERI-MOGHADASS, BEHNAM S	4/17/2018	208600000X	NA	General Surgery	026	PHYSICIANS	151143	41	Internal Medicine	0	In state provider	MD	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
258875	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
258898	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	12/20/2021	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
258904	Fee-for-Service	1164858635	1164858635	1	1	JONES, TOCINDA L	9/30/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	588 HILLSBOROUGH WAY	None	CORONA	CA	92879	6141	33	06065	33.8965082	-117.5098223	Riverside County
258919	Fee-for-Service	1932337706	1932337706	1	1	JOHANES I PRAWIRA	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
258952	Fee-for-Service	1053331538	1053331538	1	1	JAFRI, BATOOL MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71947	None	None	0	In state provider	None	444 S SAN VICENTE BLVD	STE 1102	LOS ANGELES	CA	90048	4169	19	06037	34.06999878	-118.3755119	Los Angeles County
259017	Fee-for-Service	1417005695	1417005695	1	1	JOHNSON, LORNA M CNM	7/27/2004	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	19	06037	33.97478347	-118.253943	Los Angeles County
259067	Fee-for-Service	1720035322	1720035322	1	1	JACOBY, ALISON F MD	2/1/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84010	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	FL 8	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259083	Fee-for-Service	1497323646	1497323646	1	1	JEREMY SCHWIEGER, M.D., A ME	5/4/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	DICAL CORPORATION	18840 VENTURA BLVD STE 2	None	TARZANA	CA	91356	3381	19	06037	34.17204394	-118.5442921	Los Angeles County
259084	Fee-for-Service	1801060744	1801060744	1	1	JAYA, DAYANG K MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117491	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
259160	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
259166	Fee-for-Service	1669841771	1669841771	1	1	JOERNS LLC	1/19/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1064 WOODLAND AVE	STE G	MODESTO	CA	95351	1545	50	06099	37.65317951	-121.023729	Stanislaus County
259186	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
259190	Fee-for-Service	1164858635	1164858635	1	1	JONES, TOCINDA L	9/30/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	588 HILLSBOROUGH WAY	None	CORONA	CA	92879	6141	33	06065	33.8965082	-117.5098223	Riverside County
259232	Fee-for-Service	1225031784	1225031784	1	1	JACOB & HENEIN AMC	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2230 LYNN RD	STE 230	THOUSAND OAKS	CA	91360	1984	56	06111	34.20894685	-118.885185	Ventura County
259265	Fee-for-Service	1104349927	1104349927	1	1	JAGDEEP GARCHA P.T	5/20/2021	261QP2000X	NA	Physical Therapist	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8031 FRUITRIDGE	SUITE A	SACRAMENTO	CA	95820	8031	34	06067	38.525427	-121.409577	Sacramento County
259294	Fee-for-Service	1457649618	1457649618	1	1	JIMENEZ, GENARO A	8/9/2011	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
259358	Fee-for-Service	1164056669	1164056669	1	1	JORDAN, JAMISON F PT	5/25/2020	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
259368	Fee-for-Service	1548296320	1548296320	1	1	JOW, YUNG R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50773	None	None	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
259387	Fee-for-Service	1194917302	1194917302	1	1	JENNIFER WILLIAMS	7/24/2016	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
259428	Fee-for-Service	1821121070	1821121070	1	1	JEW, CYNTHIA L PT	5/29/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	728 PACIFIC AVE STE 301	None	SAN FRANCISCO	CA	94133	4488	38	06075	37.79687859	-122.4074282	San Francisco County
259448	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	1/7/2021	208D00000X	NA	Adult Primary Care	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
259449	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	4/12/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
259468	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	8/30/2017	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
259473	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	9/28/2022	207RH0003X	NA	Oncology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
259518	Fee-for-Service	1225031784	1225031784	1	1	JACOB & HENEIN AMC	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2230 LYNN RD	STE 230	THOUSAND OAKS	CA	91360	1984	56	06111	34.20894685	-118.885185	Ventura County
259548	Fee-for-Service	1922075365	1922075365	1	1	JBARA, MARLENA E	9/22/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181254	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
259552	Fee-for-Service	1225672876	1225672876	1	1	JUHNKE, ASHLEY PT	11/11/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1350 BURTON DRIVE	STE 260	VACAVILLE	CA	95687	3545	48	06095	38.36416107	-121.9552032	Solano County
259604	Fee-for-Service	1508268301	1508268301	1	1	JOHNSON, ELI R DO	12/7/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	15010	None	None	0	In state provider	None	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	33	06065	33.837354	-116.545572	Riverside County
259608	Fee-for-Service	1265515340	1265515340	1	1	JAMES, STACY H NP	1/12/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3275 VILLA LANE	None	NAPA	CA	94558	3016	28	06055	38.32223637	-122.2927198	Napa County
259615	Fee-for-Service	1649327016	1649327016	1	1	JOHNSTON, LAURA J MD	8/5/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	70540	78	Neoplastic Diseases/Oncology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
259616	Fee-for-Service	1437131331	1437131331	1	1	JACKSON, MICHAEL E MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	69520	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 NORTH CHERRY STREET	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
259692	Fee-for-Service	1235354408	1235354408	1	2	JO, WON MD INC	2/26/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	91260	None	None	0	In state provider	None	26021 BUSINESS CENTER	None	REDLANDS	CA	92374	4553	36	06071	34.06518096	-117.2367214	San Bernardino County
259708	Fee-for-Service	1679517320	1679517320	1	1	JENNINGS, CHRIS MD	10/29/2009	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
259737	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
259738	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	4/12/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
259743	Fee-for-Service	1891202529	1891202529	1	1	JACK STEWART MD INC	3/5/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1010 W LA VETA AVENUE	STE 750	ORANGE	CA	92868	4312	30	06059	33.78028244	-117.8635552	Orange County
259754	Fee-for-Service	1497129340	1497129340	1	1	JORDAN, MICHELLE R NP	2/21/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	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
259756	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
259763	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	207RH0003X	NA	Oncology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
259770	Fee-for-Service	1669901948	1669901948	1	1	JOSEPH, MICHELLE LMFT	5/16/2023	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
259808	Fee-for-Service	1225031784	1225031784	1	1	JACOB & HENEIN AMC	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2230 LYNN RD	STE 230	THOUSAND OAKS	CA	91360	1984	56	06111	34.20894685	-118.885185	Ventura County
259875	Fee-for-Service	1215421516	1215421516	1	1	JA, RUSSELL M LMFT	7/19/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
259879	Fee-for-Service	1346348299	1346348299	1	1	JEAN SIMPSON, MD	4/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 21ST AVE S	STE 250	NASHVILLE	TN	37212	4964	00	None	36.13016371	-86.80202505	Davidson County
259904	Fee-for-Service	1649327016	1649327016	1	1	JOHNSTON, LAURA J MD	8/5/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	70540	68	Hematology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
259917	Fee-for-Service	1134459852	1134459852	1	1	JAMWAL, PRIYANSHA SEN MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112329	40	Pediatrics	0	In state provider	None	2170 E BIDWELL STREET	SUITE 100	FOLSOM	CA	95630	6466	34	06067	38.667321	-121.1435865	Sacramento County
259973	Fee-for-Service	1245376060	1245376060	1	1	JACOBS, MELISSA ANN MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88080	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259981	Fee-for-Service	1912104993	1912104993	1	1	JEAN-FRANCOIS, EROLD MD	6/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94666	18	Ophthalmology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
260010	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
260024	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	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
260026	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
260034	Fee-for-Service	1891202529	1891202529	1	1	JACK STEWART MD INC	3/5/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1010 W LA VETA AVENUE	STE 750	ORANGE	CA	92868	4312	30	06059	33.78028244	-117.8635552	Orange County
260047	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
260050	Fee-for-Service	1225403785	1225403785	1	1	JEWETT, LILYANNE MD	6/29/2020	390200000X	NA	Other	026	PHYSICIANS	157763	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
260052	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RH0003X	NA	Oncology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
260138	Fee-for-Service	1720327703	1720327703	1	1	JONES, ASHLEY LMFT	1/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	602 COMMERCE AVE	SUITE E	PALMDALE	CA	93551	3882	19	06037	34.58955354	-118.141074	Los Angeles County
260195	Fee-for-Service	1609997402	1609997402	1	1	JABOUR, BRADLEY A MD	7/8/1996	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	41876	30	Radiology	0	In state provider	None	2827 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	4801	19	06037	34.03803747	-118.4750347	Los Angeles County
260209	Fee-for-Service	1770930034	1770930034	1	1	JIMENEZ-MUNOZ, DANIELLE A LM	3/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
260298	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
260314	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
260315	Fee-for-Service	1841407665	1841407665	1	72	JOHN MUIR PHYSICIAN NETWORK	1/7/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
260318	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
260333	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	8/30/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
260335	Fee-for-Service	1841407665	1841407665	1	77	JOHN MUIR PHYSICIAN NETWORK	12/20/2021	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
260371	Fee-for-Service	1477535169	1477535169	1	1	JOSEPH G CRAMER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
260514	Fee-for-Service	1689092397	1689092397	1	1	JONG, WALTER PT	11/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
260521	Fee-for-Service	1528231347	1528231347	1	1	JUON-KIN K FONG, MD INC	1/1/1975	261QM2500X	NA	Other	026	PHYSICIANS	28848	20	Orthopedic Surgery	0	In state provider	None	2844 SUMMIT ST	# 103	OAKLAND	CA	94609	3641	01	06001	37.81754276	-122.2646445	Alameda County
260561	Fee-for-Service	1548256753	1548256753	1	1	JAMESTOWN REGIONAL MED CTR	7/14/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2422 20TH ST SW	None	JAMESTOWN	ND	58401	6201	00	None	46.890135	-98.746776	Stutsman County
260586	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
260587	Fee-for-Service	1083753776	1083753776	1	1	JACOBSON, GRETCHEN H MD	9/29/2010	193400000X	NA	Other	026	PHYSICIANS	63450	14	Neurological Surgery	0	In state provider	A PROFESSIONAL CORP	1700 N ROSE AVE	STE 250	OXNARD	CA	93030	7626	56	06111	34.21746	-119.155545	Ventura County
260598	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	12/13/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
260601	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
260605	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0001X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
260621	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
260701	Fee-for-Service	1215642418	1215642418	1	1	JACONETTY, NATALIE E	5/18/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
260836	Fee-for-Service	1093709917	1093709917	1	1	JONES, BRIAN R MD	12/31/1988	207L00000X	NA	Other	026	PHYSICIANS	60012	05	Anesthesiology	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
260854	Fee-for-Service	1811915176	1811915176	1	1	JOSEPH E LOVE MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
260871	Fee-for-Service	1295125995	1295125995	1	1	JUNG, MICHAEL J MD	7/2/2019	390200000X	NA	Other	026	PHYSICIANS	146772	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
260874	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	5/3/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General 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
260876	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208D00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
260887	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RH0003X	NA	Oncology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
260891	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
260893	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0001X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
260904	Fee-for-Service	1427295070	1427295070	1	1	JENKINS, CANA R NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260910	Fee-for-Service	1841407665	1841407665	1	54	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
260934	Fee-for-Service	1073125761	1073125761	1	1	JOURNEY PALLIATIVE AND	5/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	4405 RIVERSIDE DR	STE 204	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
260967	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
261137	Fee-for-Service	1376500488	1376500488	1	1	JAPAS, CAROL 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	11807 S FREEWAY	STE 360	FORT WORTH	TX	76115	0337	00	None	32.66099639	-97.32176732	Tarrant County
261164	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
261165	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
261175	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
261178	Fee-for-Service	1841407665	1841407665	1	51	JOHN MUIR PHYSICIAN NETWORK	3/27/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
261181	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
261225	Fee-for-Service	1073125761	1073125761	1	1	JOURNEY PALLIATIVE AND	5/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	4405 RIVERSIDE DR	STE 204	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
261256	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
261261	Fee-for-Service	1932154788	1932154788	1	1	J ROBERT WEST, M.D., INC	2/6/2020	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
261380	Fee-for-Service	1073574539	1073574539	1	1	JACOBS, STUART I MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	30790	07	Dermatology	0	In state provider	A PROFESSIONAL CORP	5345 N EL DORADO ST	STE 12	STOCKTON	CA	95207	5856	39	06077	37.99932454	-121.3063516	San Joaquin County
261426	Fee-for-Service	1871239012	1871239012	1	1	JOHNSON, KALYNN R OT	7/29/2022	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
261452	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
261453	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
261459	Fee-for-Service	1588796783	1588796783	1	1	JIMENEZ, MARLEN 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
261460	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RH0003X	NA	Oncology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
261469	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
261478	Fee-for-Service	1215225180	1215225180	1	1	JOSHUA SILVRBERG	2/26/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
261544	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
261552	Fee-for-Service	1932154788	1932154788	1	1	J ROBERT WEST, M.D., INC	2/6/2020	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
261555	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
261567	Fee-for-Service	1073732897	1073732897	1	1	JESSIE HOPKINS HINCHEE	12/22/1993	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION/JESSICA HOUSE	7174 ALAMEDA AVE	None	GOLETA	CA	93117	1352	42	06083	34.43541428	-119.8796887	Santa Barbara County
261696	Fee-for-Service	1740905322	1740905322	1	1	JKW HEALTHCARE, PROFESSIONA	12/16/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L CORPORATION	3510 E SHIELDS AVE	None	FRESNO	CA	93726	6909	10	06019	36.77948647	-119.7658665	Fresno County
261732	Fee-for-Service	1225187453	1225187453	1	1	JOHNSON, BECCA D	2/8/2008	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11930 HERITAGE OAKS PL	STE 8 & 9	AUBURN	CA	95603	2458	31	06061	38.94059662	-121.0995593	Placer County
261737	Fee-for-Service	1841407665	1841407665	1	3	JOHN MUIR PHYSICIAN NETWORK	3/2/2022	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
261740	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	3/14/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
261749	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	12/13/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
261755	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0001X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
261786	Fee-for-Service	1295945244	1295945244	1	1	JASMINE BADILLO AND TERESITA	7/10/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	219 TORREY PINES CT	None	VALLEJO	CA	94591	4333	48	06095	38.11731053	-122.1980456	Solano County
261797	Fee-for-Service	1598320418	1598320418	1	1	JIMENEZ, LINDA E MD	1/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191491	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
261830	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
261837	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
261838	Fee-for-Service	1932154788	1932154788	1	1	J ROBERT WEST, M.D., INC	2/24/2020	207NS0135X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
261842	Fee-for-Service	1902869639	1902869639	1	1	JOSEPHS, SHELLIE C MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155476	30	Radiology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
261844	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
261984	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
262028	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
262038	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RH0003X	NA	Oncology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
262044	Fee-for-Service	1841407665	1841407665	1	19	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2700 GRANT ST	STE 319	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
262119	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
262129	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	9/28/2022	208800000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
262133	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
262177	Fee-for-Service	1255795290	1255795290	1	1	JANUSZEWICZ, KATHERINE L MD	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
262271	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
262278	Fee-for-Service	1699020859	1699020859	1	1	JILAIHAWI, HASANIAN A MD	11/15/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122008	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
262315	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
262324	Fee-for-Service	1841407665	1841407665	1	65	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RH0003X	NA	Oncology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
262331	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	11/19/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
262372	Fee-for-Service	1811335326	1811335326	1	1	JOLLY, DASHEAVIA Q	11/21/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	136 S VIRGIL AVENUE	APT 2-221	LOS ANGELES	CA	90004	6062	19	06037	34.07260294	-118.2867755	Los Angeles County
262406	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
262414	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208800000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
262419	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
262505	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
262524	Fee-for-Service	1013913722	1013913722	1	1	JOHNSON, RONALD B MD	3/31/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55608	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	19	06037	34.047153	-117.2611485	San Bernardino County
262528	Fee-for-Service	1417231606	1417231606	1	1	JINDAL, VANITA MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118601	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
262559	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
262603	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
262618	Fee-for-Service	1316385925	1316385925	1	1	JAZAYERI, AMIR H MD	9/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
262619	Fee-for-Service	1225186505	1225186505	1	1	JUSTINA BRESENO M MD INC	4/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50599	40	Pediatrics	0	In state provider	None	6485 DAY ST	STE 103	RIVERSIDE	CA	92507	0930	33	06065	33.931809	-117.2789185	Riverside County
262620	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
262666	Fee-for-Service	1811335326	1811335326	1	1	JOLLY, DASHEAVIA Q	11/21/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	136 S VIRGIL AVENUE	APT 2-221	LOS ANGELES	CA	90004	6062	19	06037	34.07260294	-118.2867755	Los Angeles County
262693	Fee-for-Service	1841407665	1841407665	1	24	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
262701	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208800000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
262702	Fee-for-Service	1144665936	1144665936	1	1	JANOIAN, PAUL M III MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135069	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
262707	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
262777	Fee-for-Service	1093863995	1093863995	1	1	JAYARAMAN, MADHANGI MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78079	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
262794	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
262795	Fee-for-Service	1700029949	1700029949	1	1	JIMENEZ, ADELIZA S MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119848	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
262838	Fee-for-Service	1275611998	1275611998	1	1	JONES, KRISTI F MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61064	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
262848	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
262894	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	5/8/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
262905	Fee-for-Service	1316385925	1316385925	1	1	JAZAYERI, AMIR H MD	9/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
262908	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
262925	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
262990	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	11/23/2021	208800000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
262996	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
263081	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
263088	Fee-for-Service	1013646157	1013646157	1	1	JEFF SUNG, MD A MEDICAL CORP	2/20/2023	207PH0002X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ORATION	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
263116	Fee-for-Service	1700128626	1700128626	1	1	JOSEPH, TONY ABRAHAM MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152312	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
263138	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
263160	Fee-for-Service	1548557648	1548557648	1	1	JAVIER, ROMMEL M CRNA	5/17/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
263167	Fee-for-Service	1073825170	1073825170	1	1	JIN, BEDRO MD	6/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129285	30	Radiology	0	In state provider	None	1516 COTNER AVENUE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
263181	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	5/8/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
263196	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
263208	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
263215	Fee-for-Service	1023468261	1023468261	1	1	JAPA, SOHAN MD	9/27/2021	207R00000X	NA	Other	026	PHYSICIANS	171478	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
263225	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	4/27/2022	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
263278	Fee-for-Service	1841407665	1841407665	1	81	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	208800000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5201 NORRIS CANYON	210	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
263283	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
263299	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
263310	Fee-for-Service	1497790471	1497790471	1	1	JAMES MCALLISTER DO	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2505 US HIGHWAY 431	None	BOAZ	AL	35957	5908	00	None	34.22187416	-86.15958539	Marshall County
263349	Fee-for-Service	1720245558	1720245558	1	1	JOSEPH A DOLAN MD	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5435 FELTL RD	None	MINNETONKA	MN	55343	7983	00	None	44.90402661	-93.4197671	Hennepin County
263370	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
263412	Fee-for-Service	1396751889	1396751889	1	1	JOYE, JAMES D DO	2/1/1999	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	7349	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
263418	Fee-for-Service	1831312289	1831312289	1	1	JIANG, FEN MD	5/3/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	97283	41	Internal Medicine	0	In state provider	None	23823 VALENCIA BLVD	STE 250	SANTA CLARITA	CA	91355	9512	19	06037	34.41347743	-118.5523087	Los Angeles County
263424	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
263464	Fee-for-Service	1851657829	1851657829	1	1	JONAS, ANDREA M MD	6/15/2020	207R00000X	NA	Other	026	PHYSICIANS	147979	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
263469	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
263470	Fee-for-Service	1205873429	1205873429	1	1	JOE, DOUGLAS MD	10/31/1983	207P00000X	NA	Other	026	PHYSICIANS	37674	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
263483	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
263502	Fee-for-Service	1275897779	1275897779	1	1	JACOBS, KATHLEEN E MD	7/10/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	127521	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
263505	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
263511	Fee-for-Service	1326677238	1326677238	1	1	JACQUELINE HIRK, MARRIAGE &	4/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING INC	1400 QUAIL ST	STE 150	NEWPORT BEACH	CA	92660	2759	30	06059	33.66063101	-117.868116	Orange County
263516	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	4/27/2022	208800000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
263570	Fee-for-Service	1841407665	1841407665	1	17	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
263583	Fee-for-Service	1033228218	1033228218	1	1	JONES, ROBERT W LCSW	12/7/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21647	-	NOT APPLICABLE	0	In state provider	None	83385 ROSA AVENUE	None	THERMAL	CA	92274	9506	33	06065	33.64846105	-116.2093774	Riverside County
263588	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
263605	Fee-for-Service	1245492677	1245492677	1	1	JOHL, JASKARN S DO	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11065	18	Ophthalmology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
263616	Fee-for-Service	1851314611	1851314611	1	1	JOHNSON, LEIF A MD	1/1/1998	207P00000X	NA	Other	026	PHYSICIANS	78115	None	None	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
263658	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
263675	Fee-for-Service	1508248956	1508248956	1	1	JANKOVIC, IVANA MD	11/8/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	154922	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263682	Fee-for-Service	1265202725	1265202725	1	1	JOHN MUIR HEALTH	4/24/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	IR HEALTH	177 LA CASA VIA	270	WALNUT CREEK	CA	94598	6101	07	06013	37.91102258	-122.0394478	Contra Costa County
263700	Fee-for-Service	1396751889	1396751889	1	1	JOYE, JAMES D DO	2/1/1999	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	7349	01	General Practice	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
263715	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
263721	Fee-for-Service	1609801935	1609801935	1	1	JOHN GREGG MELTON MD	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
263756	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
263774	Fee-for-Service	1841407665	1841407665	1	63	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3480 BUSKIRK AVE	STE 110A	CONCORD	CA	94523	4397	07	06013	37.94004473	-122.0590134	Contra Costa County
263789	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
263801	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	8/11/2022	208800000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
263854	Fee-for-Service	1841473485	1841473485	1	1	JAUREGUI, NICHOLAS J MD	9/9/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	1164 NORUMBEGA DR	None	MONROVIA	CA	91016	1831	19	06037	34.16143717	-117.9790379	Los Angeles County
263873	Fee-for-Service	1285168476	1285168476	1	1	JOHNSON, JESSICA G MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	159721	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
263875	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
263879	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
263886	Fee-for-Service	1801821376	1801821376	1	1	JOHN MUIR HEALTH	1/1/1997	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CONCORD CAMPUS	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
263946	Fee-for-Service	1841407665	1841407665	1	35	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
263949	Fee-for-Service	1225206493	1225206493	1	1	JAQUE, JENNY M MD	1/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	96288	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO STREET	3RD FLOOR	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
263994	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208C00000X	NA	General Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
264001	Fee-for-Service	1841407665	1841407665	1	31	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
264044	Fee-for-Service	1841407665	1841407665	1	68	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	100 HOSPITAL	#304	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
264075	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
264089	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
264126	Fee-for-Service	1891957221	1891957221	1	1	JOTHEN, JENNIFER L DO	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10603	13	Neurology (M.D. only)	0	In state provider	None	750 MEDICAL CENTER COURT	SUITE 13	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
264155	Fee-for-Service	1487732194	1487732194	1	1	JOYE, JAMES A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29170	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
264156	Fee-for-Service	1295998375	1295998375	1	1	JAIRAM, RAJIV MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101801	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
264162	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	11/28/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
264165	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
264171	Fee-for-Service	1518555408	1518555408	1	1	JUNG-SHAARAWY, ROSE CP	2/25/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2200 PACIFIC COAST HWY	STE 102	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
264221	Fee-for-Service	1194985200	1194985200	1	1	JIMENEZ-KIMBLE, RICARDO E MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118065	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
264243	Fee-for-Service	1487959938	1487959938	1	2	JOHN TRACY CLINIC	12/16/2013	231H00000X	NA	Other	037	SPEECH THERAPISTS	-	-	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
264269	Fee-for-Service	1003386509	1003386509	1	1	JOHNSON, SHANNON	12/21/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2505 W SHAW AVE	STE. 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
264282	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208C00000X	NA	General Surgery	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
264333	Fee-for-Service	1841407665	1841407665	1	53	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3318 ELM STREET	SUITE 1	OAKLAND	CA	94609	3013	01	06001	37.82171753	-122.2652776	Alameda County
264369	Fee-for-Service	1841407665	1841407665	1	8	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
264377	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208800000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
264450	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
264452	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	9/6/2018	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
264531	Fee-for-Service	1487959938	1487959938	1	2	JOHN TRACY CLINIC	12/16/2013	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
264570	Fee-for-Service	1770525628	1770525628	1	1	JULIAN, DAVID M MD	2/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE 13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
264571	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	4/22/2019	208C00000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
264657	Fee-for-Service	1023177516	1023177516	1	1	JACKSON, JEREMY	9/11/2012	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
264665	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	12/5/2022	208800000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
264668	Fee-for-Service	1427784040	1427784040	1	1	JHA, SUJIT K MD	9/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
264733	Fee-for-Service	1720387558	1720387558	1	1	JAVAHERI, KIANOUSH MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116084	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
264737	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
264742	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208D00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
264760	Fee-for-Service	1659907582	1659907582	1	1	JACKANICH, ANNA E MD	7/31/2024	207P00000X	NA	Other	026	PHYSICIANS	179454	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
264795	Fee-for-Service	1437779543	1437779543	1	1	JOTHIKUMAR, KRISHNA MD	3/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187255	08	Family Practice	0	In state provider	None	8820 WILSHIRE BLVD	STE 110	BEVERLY HILLS	CA	90211	2618	19	06037	34.06704147	-118.3844115	Los Angeles County
264820	Fee-for-Service	1497738306	1497738306	1	1	JUE, JACK JR MD	7/19/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34658	08	Family Practice	0	In state provider	None	3637 MISSION AVE	STE 7	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
264847	Fee-for-Service	1396830915	1396830915	1	1	JARBOU, MOHAMMAD MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	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
264860	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208C00000X	NA	General Surgery	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
264877	Fee-for-Service	1447280524	1447280524	1	1	JANGA, RADHIKA R MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	5945 S RAINBOW BLVD	STE 140	LAS VEGAS	NV	89114	2560	00	None	36.08005985	-115.2427737	Clark County
264890	Fee-for-Service	1346060274	1346060274	1	1	JUDY C HENNING OPTOMETRY, PC	11/2/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	40500 MURRIETA HOT SPRIN	None	MURRIETA	CA	92563	6403	33	06065	33.55317	-117.177678	Riverside County
264902	Fee-for-Service	1841594355	1841594355	1	1	JOHNSON, NATALIA I	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123675	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
264954	Fee-for-Service	1841407665	1841407665	1	84	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208800000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 WIGET LN	207	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
264973	Fee-for-Service	1215275797	1215275797	1	1	JEON, YONG MD	11/4/2021	207R00000X	NA	Other	026	PHYSICIANS	165686	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
265017	Fee-for-Service	1811054208	1811054208	1	1	JACKSON, APRIL	9/11/2012	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
265024	Fee-for-Service	1841407665	1841407665	1	50	JOHN MUIR PHYSICIAN NETWORK	11/28/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3300 STONERIDGE CREEK WY	None	PLEASANTON	CA	94588	2200	01	06001	37.70028	-121.856454	Alameda County
265027	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
265032	Fee-for-Service	1639389554	1639389554	1	1	JARBOU & JARBOU, INC.	5/19/2009	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6975 NORTH AVE	None	LEMON GROVE	CA	91945	5413	37	06073	32.7437754	-117.0474704	San Diego County
265088	Fee-for-Service	1902484827	1902484827	1	1	JEWEL CITY HOME HEALTH INC	11/30/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1641 W MAIN ST	UNIT 302	ALHAMBRA	CA	91801	1900	19	06037	34.0915435	-118.141389	Los Angeles County
265145	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	7/2/2018	208C00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
265185	Fee-for-Service	1497725220	1497725220	1	1	JACOB, SARGON D DO	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7956	05	Anesthesiology	0	In state provider	None	2900 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98791813	-121.9781795	Santa Cruz County
265241	Fee-for-Service	1730353558	1730353558	1	1	JAMES, ANDREW E DO	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11235	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
265281	Fee-for-Service	1497703805	1497703805	1	1	JEN, TODD I MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	65346	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
265299	Fee-for-Service	1134157563	1134157563	1	1	JOSEPHSON, SCOTT A MD	2/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81308	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
265313	Fee-for-Service	1841407665	1841407665	1	61	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94513	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
265352	Fee-for-Service	1659734119	1659734119	1	1	JAMES-POSEY, GERALDA A NP	6/13/2024	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
265358	Fee-for-Service	1497198402	1497198402	1	1	JOHNSON, RUSSEL A MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149593	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
265433	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	7/2/2018	208C00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	28	Proctology (colon and rectal)	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
265443	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
265526	Fee-for-Service	1497964746	1497964746	1	1	JANECZEK, KINGA MD	12/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158172	08	Family Practice	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
265568	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
265639	Fee-for-Service	1497198402	1497198402	1	1	JOHNSON, RUSSEL A MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149593	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
265680	Fee-for-Service	1982946547	1982946547	1	1	JUN, HYEJO MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
265686	Fee-for-Service	1780666271	1780666271	1	1	JAMES G FLOURNOY, 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	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
265715	Fee-for-Service	1841407665	1841407665	1	62	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
265731	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
265811	Fee-for-Service	1659860088	1659860088	1	1	JIMENEZ, JAIME MD	10/24/2023	390200000X	NA	Other	026	PHYSICIANS	179936	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
265814	Fee-for-Service	1679771398	1679771398	1	1	JUJULIAN, KIRA S	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
265852	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
265905	Fee-for-Service	1336435015	1336435015	1	1	JONES, LEON D.	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	54604	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
265968	Fee-for-Service	1861531808	1861531808	1	1	JOHNSON, BRIAN M MD	4/19/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109724	08	Family Practice	0	In state provider	None	3466 MT DIABLO BLVD	#C 100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
266008	Fee-for-Service	1861685349	1861685349	1	1	JOHNSON, CHRISTINE L MD	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111726	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
266013	Fee-for-Service	1730231895	1730231895	1	1	JOE'S PHARMACY	6/11/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5199 GEARY BLVD	None	SAN FRANCISCO	CA	94118	2815	38	06075	37.78046515	-122.4749066	San Francisco County
266016	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
266064	Fee-for-Service	1831261650	1831261650	1	1	JACQUES, TERESA W MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70904	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
266141	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
266237	Fee-for-Service	1588919971	1588919971	1	1	JENG, KAICHIN MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136465	41	Internal Medicine	0	In state provider	None	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
266269	Fee-for-Service	1003051780	1003051780	1	1	JIN, WENWU MD	12/29/2009	208800000X	NA	Other	026	PHYSICIANS	106793	34	Urology and Urological Surgery	0	In state provider	None	929 CLAY ST	#505	SAN FRANCISCO	CA	94108	1500	38	06075	37.79398652	-122.4083496	San Francisco County
266299	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
266307	Fee-for-Service	1760945315	1760945315	1	1	JASSAL, RIPSY	9/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179350	None	None	0	In state provider	None	1335 S FAIRMONT AVE	None	LODI	CA	95240	5520	39	06077	38.115882	-121.2857775	San Joaquin County
266350	Fee-for-Service	1831261650	1831261650	1	1	JACQUES, TERESA W MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70904	67	Endocrinology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
266420	Fee-for-Service	1760989222	1760989222	1	1	JAKA, SARA Y MD	11/9/2021	207R00000X	NA	Other	026	PHYSICIANS	173770	None	None	0	In state provider	None	2220 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
266424	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
266448	Fee-for-Service	1073992079	1073992079	1	1	JOBES, JOHN P DO	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2306	00	None	36.132948	-115.136874	Clark County
266520	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
266521	Fee-for-Service	1639214851	1639214851	1	1	JU, JOHN T OD	7/1/1976	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	616 N GARFIELD AVE	STE 100	MONTEREY PARK	CA	91754	1153	19	06037	34.06916465	-118.1229039	Los Angeles County
266585	Fee-for-Service	1245929470	1245929470	1	1	JAEGER, CHRISTINA CNP	12/4/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
266587	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
266607	Fee-for-Service	1235206335	1235206335	1	1	JAHANIAN, KEVIN S LMFT	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87449	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
266709	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
266802	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
266820	Fee-for-Service	1073716692	1073716692	1	1	JIBILIAN, AREK A MD	8/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97689	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
266852	Fee-for-Service	1881701514	1881701514	1	1	JEY, ARTHUR R MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123674	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
266874	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
266935	Fee-for-Service	1710171582	1710171582	1	1	JAVED, SHAHID MD	1/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103689	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
266938	Fee-for-Service	1811920325	1811920325	1	1	JURKOWITZ, SUSAN W PHD	5/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9911 W PICO BLVD	STE 1550	LOS ANGELES	CA	90035	2712	19	06037	34.05336328	-118.4040952	Los Angeles County
266946	Fee-for-Service	1336174655	1336174655	1	1	JOHNSON, ROYCE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	21369	01	General Practice	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
266964	Fee-for-Service	1225069123	1225069123	2	1	JENKIN, FREDERICK D DO	5/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5034	08	Family Practice	0	In state provider	O	7050 PARKWAY DRIVE	None	LA MESA	CA	91942	1535	37	06073	32.77442023	-117.0445607	San Diego County
266994	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
267086	Fee-for-Service	1730240110	1730240110	1	1	JAIN, REENA MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31421	40	Pediatrics	0	In state provider	None	2105 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57779415	-122.393424	Shasta County
267090	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
267106	Fee-for-Service	1073716692	1073716692	1	1	JIBILIAN, AREK A MD	8/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97689	38	Geriatrics	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
267124	Fee-for-Service	1538594098	1538594098	1	1	JONES, MEGAN E 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
267158	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
267166	Fee-for-Service	1538190806	1538190806	1	1	JOSHI, ROHINI J MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79624	13	Neurology (M.D. only)	0	In state provider	None	5400 W HILLSDALE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
267235	Fee-for-Service	1588951271	1588951271	1	1	JONES, JACOB K DPM	8/1/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1038 E CHAPMAN AVE	None	ORANGE	CA	92866	2111	30	06059	33.78782652	-117.84249	Orange County
267279	Fee-for-Service	1841407665	1841407665	1	5	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	907 SAN RAMON VALLEY BLV	STE 104	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
267332	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
267372	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
267437	Fee-for-Service	1013084987	1013084987	1	1	JENSEN, CHRIS C MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74279	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
267439	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
267494	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207V00000X	NA	Obstetrics & Gynecology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
267496	Fee-for-Service	1841428323	1841428323	1	1	JEN, HOWARD C MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	100000	85	Surgery-Pediatric	0	In state provider	None	200 MEDICAL PLAZA	STE 526	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
267524	Fee-for-Service	1871559039	1871559039	1	1	JAMES L HENDRIX MD	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 W MEMORIAL RD	None	OKLAHOMA CITY	OK	73120	8304	00	None	35.606601	-97.6003605	Oklahoma County
267537	Fee-for-Service	1093783953	1093783953	1	1	JASKAMAL P KAHLON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6750 E BAYWOOD AVE	STE 301	MESA	AZ	85206	1747	00	None	33.411195	-111.685365	Maricopa County
267552	Fee-for-Service	1528505377	1528505377	1	1	JOHNSTON, MARIE G NP	2/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8460 NUEVO AVENUE	7	FONTANA	CA	92335	3824	36	06071	34.10006903	-117.4369875	San Bernardino County
267599	Fee-for-Service	1417158981	1417158981	1	1	JOHAL, SUKHI MD	6/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54912	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
267614	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
267653	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
267661	Fee-for-Service	1700597069	1700597069	1	1	JONES, RAJAE OT	4/25/2023	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1251 E DYER RD	SUITE 150	SANTA ANA	CA	92705	5662	30	06059	33.70870351	-117.8551005	Orange County
267666	Fee-for-Service	1720534803	1720534803	1	1	JAIN, ROHINI MD	7/8/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	172291	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
267723	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
267739	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
267778	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207V00000X	NA	Obstetrics & Gynecology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
267833	Fee-for-Service	1699182113	1699182113	1	1	JOSHI, VIBHA M MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151764	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
267884	Fee-for-Service	1871945048	1871945048	1	1	JOHNS, LANCE LMFT	5/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
267897	Fee-for-Service	1649601550	1649601550	1	1	JANUS OF SANTA CRUZ	7/1/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	284 PENNSYLVANIA DR	SUITE 1,2	WATSONVILLE	CA	95076	3768	44	06087	36.9185029	-121.7714143	Santa Cruz County
267898	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	8/11/2022	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
267906	Fee-for-Service	1588934301	1588934301	1	1	JONES, ASHLEY L PSYD	3/25/2020	103TC0700X	NA	Mental Health Outpatient Services	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
267938	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
267961	Fee-for-Service	1982792578	1982792578	1	1	JIMENEZ, CARLOS F MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46465	04	Otology, Laryngology, Rhinology	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
267986	Fee-for-Service	1134171812	1134171812	1	1	JENNIFER GAIL VELTKAMP, 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	0000	00	None	32.812245	-96.841584	Dallas County
268007	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268024	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	1835X0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
268039	Fee-for-Service	1841407665	1841407665	1	92	JOHN MUIR PHYSICIAN NETWORK	5/6/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	12677 ALCOSTA BLVD	STE 220	SAN RAMON	CA	94583	4423	07	06013	37.77574358	-121.9604905	Contra Costa County
268061	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	9/14/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268158	Fee-for-Service	1699859520	1699859520	1	1	J CHANBONPIN MD INC	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	39381	30	Radiology	0	In state provider	None	235 N HOOVER ST	None	LOS ANGELES	CA	90004	3627	19	06037	34.07580952	-118.283404	Los Angeles County
268180	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
268219	Fee-for-Service	1841407665	1841407665	1	18	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2101 VALE RD	STE 201	SAN PABLO	CA	94806	3845	07	06013	37.95420174	-122.3372902	Contra Costa County
268251	Fee-for-Service	1326521329	1326521329	1	1	JNZ MEDICAL ACUPUNCTURE	12/26/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1828 EL CAMINO REAL	SUITE 804	BURLINGAME	CA	94010	3124	41	06081	37.59552262	-122.3838771	San Mateo County
268252	Fee-for-Service	1982792578	1982792578	1	1	JIMENEZ, CARLOS F MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46465	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
268253	Fee-for-Service	1093169831	1093169831	1	1	JOSE, DONNA MD	7/29/2021	207RR0500X	NA	Other	026	PHYSICIANS	150877	None	None	0	In state provider	None	12456 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96757592	-118.046351	Los Angeles County
268288	Fee-for-Service	1841407665	1841407665	1	6	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	STE 300	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268307	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	207RH0000X	NA	Hematology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
268344	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	9/14/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268382	Fee-for-Service	1265787659	1265787659	1	2	JONES, AMBER L DO	6/13/2019	2086S0127X	NA	General Surgery	026	PHYSICIANS	12558	02	General Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
268420	Fee-for-Service	1235236902	1235236902	1	1	JUDITH A REVA, DO	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6316 PRECINCT LINE RD	None	HURST	TX	76054	2766	00	None	32.863338	-97.18610249	Tarrant County
268463	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	12/5/2022	208D00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
268544	Fee-for-Service	1710035506	1710035506	1	1	JADVAR, REZA N MD	2/1/2000	207P00000X	NA	Other	026	PHYSICIANS	66018	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
268557	Fee-for-Service	1285261586	1285261586	1	1	JOHNSON, ALEXIS K MD	10/16/2023	261QU0200X	NA	Other	026	PHYSICIANS	186424	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
268571	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
268589	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	1835X0200X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
268607	Fee-for-Service	1164956314	1164956314	1	1	JAIN, SNEHA MD	11/4/2022	208M00000X	NA	Other	026	PHYSICIANS	159328	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
268623	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207V00000X	NA	Obstetrics & Gynecology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268648	Fee-for-Service	1649807686	1649807686	1	1	JARIWALLA, NEIL R MD	7/25/2023	207R00000X	NA	Other	026	PHYSICIANS	187698	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
268682	Fee-for-Service	1295970812	1295970812	1	1	JOCHIM, ANGELICA R LMFT	8/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7765 HEALDSBURG AVE	STE 7	SEBASTOPOL	CA	95472	3310	49	06097	38.40525805	-122.8342649	Sonoma County
268745	Fee-for-Service	1841407665	1841407665	1	82	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3480 BUSKIRK AVE	150A	PLEASANT HILL	CA	94523	4341	07	06013	37.94004473	-122.0590134	Contra Costa County
268768	Fee-for-Service	1245557784	1245557784	1	1	JOSHUA S. MASON M.D.	2/10/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	2369	00	None	33.486606	-112.071654	Maricopa County
268793	Fee-for-Service	1003235375	1003235375	1	1	JUAREZ, ROXANNA D MD	7/10/2020	207U00000X	NA	Other	026	PHYSICIANS	159966	42	Nuclear Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268806	Fee-for-Service	1649893108	1649893108	1	1	JONES, JULIANA MD	8/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184760	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
268849	Fee-for-Service	1699866079	1699866079	1	1	JOHNSON, SANDRA C MD	11/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58830	08	Family Practice	0	In state provider	None	635 ANDERSON RD	STE 10	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
268854	Fee-for-Service	1841407665	1841407665	1	91	JOHN MUIR PHYSICIAN NETWORK	4/7/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 GRANT ST	309	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
268872	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	12/5/2022	1835X0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
268908	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
268939	Fee-for-Service	1710927314	1710927314	1	1	JOE, BONNIE N MD	3/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82790	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
268943	Fee-for-Service	1033422167	1033422167	1	1	JANKOVIC, BOJANA MD	2/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118658	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
268962	Fee-for-Service	1730389800	1730389800	1	1	JEFFERSON, RONALD E MD	4/24/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	29488	-	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
269015	Fee-for-Service	1790815504	1790815504	1	1	J & P MURPHY	1/1/1979	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2557 MOWRY AVE	SUITE 31	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
269036	Fee-for-Service	1689719494	1689719494	1	1	JEFFREY TODD GERTON MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	79-1019 HAUKAPILA ST	None	KEALAKEKUA	HI	96750	7920	00	None	19.519965	-155.918154	Hawaii County
269077	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
269105	Fee-for-Service	1144989427	1144989427	1	1	JURIC, MATTHEW A PT	8/1/2023	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
269132	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
269152	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	207RH0000X	NA	Hematology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
269190	Fee-for-Service	1841407665	1841407665	1	70	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207V00000X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
269193	Fee-for-Service	1518378413	1518378413	1	1	JAMEEL, NASEER I MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137866	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
269214	Fee-for-Service	1396897195	1396897195	1	1	JIN, FU-YOU MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69645	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
269231	Fee-for-Service	1285761379	1285761379	1	1	JAMATI, MOIRA K	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
269287	Fee-for-Service	1013958230	1013958230	1	1	JAIN, SHUBHA M MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54399	05	Anesthesiology	0	In state provider	None	1350 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2898	56	06111	34.27163453	-118.7729325	Ventura County
269321	Fee-for-Service	1831192319	1831192319	1	1	JAMAL A RAZZACK	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10837 KATY FWY	STE 250	HOUSTON	TX	77079	2205	00	None	29.78396116	-95.56826546	Harris County
269357	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
269412	Fee-for-Service	1841407665	1841407665	1	32	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2305 CAMINO RAMON	STE 120	SAN RAMON	CA	94583	1394	07	06013	37.77544224	-121.9657563	Contra Costa County
269440	Fee-for-Service	1841407665	1841407665	1	83	JOHN MUIR PHYSICIAN NETWORK	8/11/2022	1835X0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
269458	Fee-for-Service	1841407665	1841407665	1	86	JOHN MUIR PHYSICIAN NETWORK	1/30/2024	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2685 PLEASANT HILL RD	C/D	PLEASANT HILL	CA	94523	2098	07	06013	37.95560644	-122.0903419	Contra Costa County
269465	Fee-for-Service	1215073572	1215073572	1	1	JACOBSON, JOANNE F MD	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52210	05	Anesthesiology	0	In state provider	None	1700 SAN PABLO AVE	SUITE D	PINOLE	CA	94564	2082	07	06013	38.00427797	-122.2971175	Contra Costa County
269498	Fee-for-Service	1992762520	1992762520	1	1	JENKINS, IAN H MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87009	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
269505	Fee-for-Service	1770575631	1770575631	1	1	JAMES J. HINES, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ARIZONA CARDIOLOGY	340 E. PALM LANE #A175	None	PHOENIX	AZ	85004	0000	00	None	33.469812	-112.0681485	Maricopa County
269512	Fee-for-Service	1780145573	1780145573	1	1	JUNG, YE LA MD	7/17/2024	207K00000X	NA	Other	026	PHYSICIANS	179217	03	Allergy	0	In state provider	None	1140 W LA VETA AVE	SUITE 850	ORANGE	CA	92868	4218	30	06059	33.7802984	-117.8651669	Orange County
269526	Fee-for-Service	1689823627	1689823627	1	1	JARAMILLO, CARLA PHD	1/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
269603	Fee-for-Service	1801382510	1801382510	1	1	JANG, ERIKA CNM	9/24/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	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
269636	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
269697	Fee-for-Service	1164688479	1164688479	1	1	JACOB ROBERT TJADEN 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	1406 6TH AVE N	None	ST CLOUD	MN	56303	0000	00	None	45.5746739	-94.17010435	Stearns County
269735	Fee-for-Service	1639279573	1639279573	1	1	J. JARED SPEAKMAN	3/12/2019	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	4488	00	None	37.09513991	-113.5502324	Washington County
269748	Fee-for-Service	1447575147	1447575147	1	1	JUNG, HENRY MD	3/22/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	118916	14	Neurological Surgery	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
269880	Fee-for-Service	1619293909	1619293909	1	1	JINDAL, RISHI MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149221	24	Plastic Surgery	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
269917	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
270045	Fee-for-Service	1023089984	1023089984	1	1	JACKSON TENNESSEE HOSPITAL	11/19/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	367 HOSPITAL BLVD	None	JACKSON	TN	38305	2080	00	None	35.6837528	-88.85306267	Madison County
270127	Fee-for-Service	1942357017	1942357017	1	1	JAMBORCIC, PETAR MD	6/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	8285 W ARBY AVE	STE 390	LAS VEGAS	NV	89113	2235	00	None	36.0592099	-115.2720575	Clark County
270161	Fee-for-Service	1619293909	1619293909	1	1	JINDAL, RISHI MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149221	46	Hand Surgery	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
270188	Fee-for-Service	1053805200	1053805200	1	1	JHITA, RUSNA K MD	9/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178936	None	None	0	In state provider	None	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	07	06013	37.91229899	-122.0423696	Contra Costa County
270191	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
270194	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
270259	Fee-for-Service	1073035044	1073035044	1	1	JACQUEZ, JORDAN M MD	5/16/2023	207RR0500X	NA	Other	026	PHYSICIANS	172920	None	None	0	In state provider	None	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
270278	Fee-for-Service	1578662466	1578662466	1	1	JULIA ROSE DAVISON	5/7/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FOUCH & SON PHARMACY	692 E STREET	None	WILLIAMS	CA	95987	0039	06	06011	39.15471937	-122.1495477	Colusa County
270322	Fee-for-Service	1023089984	1023089984	1	1	JACKSON TENNESSEE HOSPITAL	11/19/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	367 HOSPITAL BLVD	None	JACKSON	TN	38305	2080	00	None	35.6837528	-88.85306267	Madison County
270471	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
270473	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
270499	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
270523	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
270586	Fee-for-Service	1356418107	1356418107	1	1	JO, ALICIA NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1511 W GARVEY AVE NORTH	None	WEST COVINA	CA	91790	2703	19	06037	34.07275848	-117.938241	Los Angeles County
270671	Fee-for-Service	1407014145	1407014145	1	1	JAMES, CARLISSA LMFT	3/25/2025	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
270728	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	2085R0001X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
270741	Fee-for-Service	1578826095	1578826095	1	1	JHA, SACHIN K MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142098	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
270746	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
270750	Fee-for-Service	1841407665	1841407665	1	22	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
270751	Fee-for-Service	1932690294	1932690294	1	1	JODY, NICOLE M MD	6/13/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	179129	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
270757	Fee-for-Service	1255332979	1255332979	1	1	JAN, HONG-AN MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31743	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12555 GARDEN GROVE BLVD	#202	GARDEN GROVE	CA	92843	1902	30	06059	33.77450946	-117.913041	Orange County
270775	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
270801	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
270983	Fee-for-Service	1518181387	1518181387	1	1	JOHNSON, DAVID MD	1/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
271006	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	2085R0001X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
271026	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
271057	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
271079	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	6/19/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
271089	Fee-for-Service	1326272055	1326272055	1	1	JEAN, DOMINIQUE A MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108347	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
271091	Fee-for-Service	1568570018	1568570018	1	1	JOHNSON, JACK L LMFT	12/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	3576 ARLINGTON AVE	SUITE 307	RIVERSIDE	CA	92506	3943	33	06065	33.94625192	-117.3913739	Riverside County
271100	Fee-for-Service	1770689911	1770689911	1	1	JOHN SCOTT TAYLOR M.D.	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 15TH AVE SE	None	PUYALLUP	WA	98372	3715	00	None	47.17745153	-122.2900155	Pierce County
271208	Fee-for-Service	1497989008	1497989008	1	1	JAIN, BHAWNA MD INC	12/7/2010	207R00000X	NA	Other	026	PHYSICIANS	68306	41	Internal Medicine	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
271240	Fee-for-Service	1225053325	1225053325	1	1	JAMMAL, JOSEPH J MD	10/14/1980	174400000X	NA	Other	026	PHYSICIANS	35975	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 250	ROSEVILLE	CA	95661	3037	31	06061	38.76507948	-121.2477476	Placer County
271263	Fee-for-Service	1922539907	1922539907	1	1	JONATHAN MOSER	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	211 CRAWFORD MEMORIAL DR	None	VAN BUREN	AR	72956	5322	00	None	35.43534	-94.338846	Crawford County
271278	Fee-for-Service	1417929506	1417929506	1	1	JAMES R FISHMAN	10/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9100 N 2ND ST	STE 201	PHOENIX	AZ	85020	2450	00	None	33.569073	-112.072104	Maricopa County
271284	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
271304	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
271333	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
271357	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
271382	Fee-for-Service	1487677589	1487677589	1	1	JOHNSON, JULIUS M PHD	12/16/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3410 GEARY BLVD	STE 328	SAN FRANCISCO	CA	94118	3557	38	06075	37.78149475	-122.4557465	San Francisco County
271455	Fee-for-Service	1134756422	1134756422	1	1	JOSHI, MUGDHA MD	6/12/2023	207R00000X	NA	Other	026	PHYSICIANS	186095	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271483	Fee-for-Service	1497989008	1497989008	1	1	JAIN, BHAWNA MD INC	12/7/2010	207R00000X	NA	Other	026	PHYSICIANS	68306	38	Geriatrics	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
271489	Fee-for-Service	1679681837	1679681837	1	1	JACQUES, DANA R MD	2/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88578	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8207 SIERRA COLLEGE BLVD	STE 500	ROSEVILLE	CA	95661	9407	31	06061	38.74777516	-121.2263996	Placer County
271494	Fee-for-Service	1538690318	1538690318	1	1	JAMES, MELISSA MD	2/20/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
271506	Fee-for-Service	1700269552	1700269552	1	1	JOHNSON, CRAIG R DO	12/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16461	40	Pediatrics	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
271515	Fee-for-Service	1043398670	1043398670	1	1	JOHNSON, JAMES E MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	25810	46	Hand Surgery	0	In state provider	None	400 PARNASSUS AVE	# A630	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271558	Fee-for-Service	1528440369	1528440369	1	1	JACOLBIA, ELIZABETH P PT	11/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
271562	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	2085R0001X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
271583	Fee-for-Service	1841407665	1841407665	1	25	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 BALFOUR RD	SUITE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
271614	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
271632	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
271636	Fee-for-Service	1063826832	1063826832	1	1	JOHNSON, PAUL MD	12/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186705	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
271791	Fee-for-Service	1558781112	1558781112	1	1	JARRELL, BRITTANY A CNP	5/14/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1400 S. GRAND AVE	SUITE 707	LOS ANGELES	CA	90015	2881	19	06037	34.03692236	-118.2655238	Los Angeles County
271836	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	10/5/2021	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
271889	Fee-for-Service	1841407665	1841407665	1	29	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4826	07	06013	37.77383963	-121.9239786	Contra Costa County
271908	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	6/19/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
271911	Fee-for-Service	1699185603	1699185603	1	1	JIANG, PENGBO MD	5/19/2019	208800000X	NA	Other	026	PHYSICIANS	142230	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
271923	Fee-for-Service	1942274261	1942274261	1	1	JAMES, TAMMI R MD	4/23/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	84974	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
271933	Fee-for-Service	1992486260	1992486260	1	1	JIN, ELENA CRNA	9/4/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
271962	Fee-for-Service	1205968336	1205968336	1	1	JONES, LEE B LMFT	8/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4216 KIERNAN AVE	SUITE 205	MODESTO	CA	95356	9758	50	06099	37.71094679	-121.0728695	Stanislaus County
271989	Fee-for-Service	1700037884	1700037884	1	1	JANOO, AHSAN S MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146274	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
272005	Fee-for-Service	1871609404	1871609404	1	1	JIMENEZ, ANDRES MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55250	None	None	0	In state provider	None	1350 W 6TH ST	STE 2	SAN PEDRO	CA	90732	3583	19	06037	33.7388545	-118.306602	Los Angeles County
272011	Fee-for-Service	1568405603	1568405603	1	1	JACOBSEN, ERIC J MD	12/1/1998	207P00000X	NA	Other	026	PHYSICIANS	63033	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
272030	Fee-for-Service	1003983834	1003983834	1	1	JONES, TERESA J DO	4/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8703	None	None	0	In state provider	None	2070 CLINTON AVE	# 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
272072	Fee-for-Service	1366809774	1366809774	1	1	JACKSON, YVETTE LMFT	3/3/2023	101YA0400X	NA	Other	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
272111	Fee-for-Service	1841407665	1841407665	1	76	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 TAYLOR	105	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
272171	Fee-for-Service	1942765045	1942765045	1	1	JAMES, SHANNA NP	8/23/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
272182	Fee-for-Service	1841407665	1841407665	1	60	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 330	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
272191	Fee-for-Service	1801897103	1801897103	1	1	JALIL, MARIA MD	2/8/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40863	41	Internal Medicine	0	In state provider	None	14350 WHITTIER BLVD	STE 200	WHITTIER	CA	90605	2148	19	06037	33.95501294	-118.0185665	Los Angeles County
272319	Fee-for-Service	1811077084	1811077084	1	1	JALILI, MEHRDAD MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44450	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
272331	Fee-for-Service	1942626684	1942626684	1	1	JOHNSON-TAYLOR, CASIE 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
272348	Fee-for-Service	1962998294	1962998294	1	1	JEWETT, DEVANTE L LCSW	10/26/2023	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
272349	Fee-for-Service	1730118118	1730118118	1	1	JAKOBSEN, MICHAEL K MD	2/1/2000	174400000X	NA	Other	026	PHYSICIANS	83103	04	Otology, Laryngology, Rhinology	0	In state provider	None	27800 MEDICAL CENTER RD	STE 324	MISSION VIEJO	CA	92691	6409	30	06059	33.55952733	-117.6645199	Orange County
272358	Fee-for-Service	1710148937	1710148937	1	1	JEWKES, JONATHAN S MD	8/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125575	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
272511	Fee-for-Service	1184264517	1184264517	1	1	JOSIAH, MICHAEL NP	10/11/2021	363LF0000X	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
272548	Fee-for-Service	1841333614	1841333614	1	1	JEVTOVIC-TODOROVIC, VESNA D	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
272563	Fee-for-Service	1689712499	1689712499	1	1	JAHANGIRI, RASHID A MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117553	36	Psychiatry	0	In state provider	None	1320 STANDIFORD AVENUE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
272572	Fee-for-Service	1013027085	1013027085	1	1	JEFFREY PRINCE	11/1/2018	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
272600	Fee-for-Service	1902381155	1902381155	1	1	JARDINE, LAURA CNP	3/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	660 BAKER STREET	STE A-102	COSTA MESA	CA	92626	4407	30	06059	33.68014263	-117.8842009	Orange County
272735	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	9/28/2022	208800000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
272801	Fee-for-Service	1265622625	1265622625	1	1	JEFFREY A BLANCHE MD	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	725 S WAHANNA RD	None	SEASIDE	OR	97138	7735	00	None	45.99034686	-123.9131204	Clatsop County
272831	Fee-for-Service	1679592976	1679592976	1	1	JUE, DEREK J MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52948	08	Family Practice	0	In state provider	None	35500 DUMBARTON CT	None	NEWARK	CA	94560	1127	01	06001	37.54845303	-122.0528	Alameda County
272841	Fee-for-Service	1528262656	1528262656	1	1	JEON, MICHAEL J MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67552	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
272847	Fee-for-Service	1912259573	1912259573	1	1	JOYCE, STEPHANIE OT	1/7/2020	101YM0800X	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
272921	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
272951	Fee-for-Service	1942204490	1942204490	1	3	JAMES D TATE MD	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	PATIENTS HOSP OF REDDING	2900 EUREKA WAY	None	REDDING	CA	96001	0220	45	06089	40.58549966	-122.4167649	Shasta County
272976	Fee-for-Service	1043664857	1043664857	1	1	JESSICA CHONG	1/20/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13768 ROSWELL AVE	STE 107	CHINO	CA	91710	1401	36	06071	34.0038	-117.7218555	San Bernardino County
273001	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	1/5/2022	208800000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
273036	Fee-for-Service	1649723446	1649723446	1	1	JENNA MARIE NIELSEA	10/31/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
273114	Fee-for-Service	1932147303	1932147303	1	1	JOHN SUNEW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19770 KINGSLAND BLVD	STE 340	HOUSTON	TX	77094	1033	00	None	29.778147	-95.7134745	Harris County
273158	Fee-for-Service	1851850887	1851850887	1	1	JOSEPH, ASHLEY MD	10/14/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
273190	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
273247	Fee-for-Service	1548295926	1548295926	1	1	JONES, LESTER J DPM	6/22/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1495	19	06037	34.32450186	-118.4456317	Los Angeles County
273249	Fee-for-Service	1669929949	1669929949	1	1	JUNG, PEGGY D NP	6/5/2023	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
273271	Fee-for-Service	1417390220	1417390220	1	1	JONES, JENNIFER LCSW	2/4/2025	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
273274	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	208800000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
273283	Fee-for-Service	1700898103	1700898103	1	2	JEFFREY M. SMITH, M.D., INC.	1/19/2021	207XX0801X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	E SPECIALSTS MEDICAL COR	3750 CONVOY ST	SUITE 201	SAN DIEGO	CA	92111	3738	37	06073	32.81201122	-117.1531108	San Diego County
273286	Fee-for-Service	1356874143	1356874143	1	1	JAMALI, MEHRAN MD	11/30/2020	207R00000X	NA	Other	026	PHYSICIANS	170059	None	None	0	In state provider	None	1949 GRANT RD	None	MOUNTAIN VIEW	CA	94040	3217	43	06085	37.373544	-122.0776945	Santa Clara County
273343	Fee-for-Service	1861655441	1861655441	1	1	JIDARIAN, ANOUSH MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108714	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
273377	Fee-for-Service	1215062435	1215062435	1	1	JACKSON, TSELANE E LVN	11/28/2006	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10620 SUNBURST DR	None	RANCHO CUCAMONGA	CA	91730	6309	36	06071	34.11879235	-117.5735131	San Bernardino County
273459	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
273540	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	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
273544	Fee-for-Service	1205093895	1205093895	1	1	JONES, KRISTOFER J MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126262	25	Physical Medicine and Rehabilitation	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
273596	Fee-for-Service	1023632080	1023632080	1	1	JACKSON, SARA A LPCC	3/26/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
273644	Fee-for-Service	1215062435	1215062435	1	1	JACKSON, TSELANE E LVN	11/28/2006	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10620 SUNBURST DR	None	RANCHO CUCAMONGA	CA	91730	6309	36	06071	34.11879235	-117.5735131	San Bernardino County
273727	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
273752	Fee-for-Service	1609960087	1609960087	1	1	JACKSON, JAMIE A MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94333	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
273790	Fee-for-Service	1144358706	1144358706	1	1	JACOBSON, DAVID F MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66695	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
273808	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	9/7/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
273820	Fee-for-Service	1407968662	1407968662	1	1	JAIDKA, SUMAN MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89498	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
273944	Fee-for-Service	1699846774	1699846774	1	1	JEFFERSON PHARMACY	12/27/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1029 JEFFERSON BLVD	STE A	WEST SACRAMENTO	CA	95691	3344	57	06113	38.57381839	-121.524014	Yolo County
273986	Fee-for-Service	1801967047	1801967047	1	1	JOEL M BLACKBURN, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1125 MADISON ST	None	JEFFERSON CTY	MO	65101	5227	00	None	38.56664773	-92.18204118	Cole County
273995	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274040	Fee-for-Service	1881024925	1881024925	1	1	JOHNSON, HARRIET G LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
274072	Fee-for-Service	1881689073	1881689073	1	1	JACOBSON, SHEILA 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	920 FROSTWOOD	None	HOUSTON	TX	77024	2314	00	None	29.782206	-95.54770351	Harris County
274076	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208800000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
274117	Fee-for-Service	1689803355	1689803355	1	1	JUSTIN TODD BUCHANAN M.D.	12/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	975 E 3RD ST	# 376	CHATTANOOGA	TN	37403	2173	00	None	35.047964	-85.29090309	Hamilton County
274190	Fee-for-Service	1639559552	1639559552	1	1	JOSHUA TREE HEALTHCARE INC	3/1/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2545 WEST HILLCREST DR	SUITE 130A	THOUSAND OAKS	CA	91320	2296	56	06111	34.18762436	-118.9332612	Ventura County
274191	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	10/8/2021	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
274258	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274278	Fee-for-Service	1174110837	1174110837	1	1	JANNESEN, ASHLEY L NP	1/6/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
274339	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274392	Fee-for-Service	1215043229	1215043229	1	1	JOHANSON, GARY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32438	08	Family Practice	0	In state provider	None	1144 SONOMA AVE	STE 121	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
274458	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207RH0003X	NA	Oncology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
274525	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274605	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	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
274611	Fee-for-Service	1235186669	1235186669	1	1	JOHNSON, CHRISTOPHER D	5/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
274617	Fee-for-Service	1477660538	1477660538	1	1	JAGIRDAR, JAISHREE 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	7703 FLOYD CURL DR	MS 7977	SAN ANTONIO	TX	78229	3901	00	None	29.506707	-98.576019	Bexar County
274655	Fee-for-Service	1215043229	1215043229	1	1	JOHANSON, GARY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32438	41	Internal Medicine	0	In state provider	None	1144 SONOMA AVE	STE 121	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
274722	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207RH0003X	NA	Oncology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
274750	Fee-for-Service	1033172754	1033172754	1	1	JAVIER, JOYCE R MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80169	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
274789	Fee-for-Service	1841407665	1841407665	1	43	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 250B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274822	Fee-for-Service	1801155585	1801155585	1	1	JONATHAN KAPLAN	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 142	PHOENIX	AZ	85013	3449	00	None	33.49179	-112.07844	Maricopa County
274861	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
274866	Fee-for-Service	1205182953	1205182953	1	1	JEAN, TIFFANY MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126760	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
274874	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
274880	Fee-for-Service	1932329331	1932329331	1	1	JENQ, ROBERT MD	8/6/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
274902	Fee-for-Service	1710312228	1710312228	1	1	J ARIAS MEDICAL CORPORATION	3/23/2015	207R00000X	NA	Other	026	PHYSICIANS	55350	41	Internal Medicine	0	In state provider	None	2211 EAST ST	None	CONCORD	CA	94520	2013	07	06013	37.98104872	-122.0328389	Contra Costa County
274945	Fee-for-Service	1013356534	1013356534	1	1	JENNIFER GERO	12/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1311 N MILDRED RD	None	CORTEZ	CO	81321	2231	00	None	37.36196474	-108.5727346	Montezuma County
274986	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	4/5/2022	207RH0003X	NA	Oncology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
275040	Fee-for-Service	1508326075	1508326075	1	1	JOSHI, FRANCES M CRNA	6/24/2020	390200000X	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
275041	Fee-for-Service	1215015482	1215015482	1	1	JOHNSON, BOYD A DO INC	5/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7291	08	Family Practice	0	In state provider	None	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
275108	Fee-for-Service	1760242424	1760242424	1	3	JOERNS HEALTHCARE LLC	4/25/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3179 & 3191 DIABLO AVE	None	HAYWARD	CA	94545	2701	01	06001	37.635752	-122.1241375	Alameda County
275121	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
275129	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208800000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
275141	Fee-for-Service	1932329331	1932329331	1	1	JENQ, ROBERT MD	8/6/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
275226	Fee-for-Service	1699781146	1699781146	1	1	JOHN G HUNTER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OREGON HEALTH & SCIENCES	3181 SW SAM JACKSON PK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
275246	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	10/8/2021	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
275247	Fee-for-Service	1669561585	1669561585	1	1	JOB, CRAIG M MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77243	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
275370	Fee-for-Service	1053597005	1053597005	1	1	JOW, VERONICA M MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109518	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
275376	Fee-for-Service	1306008297	1306008297	1	1	JEWELL, CAROLYN ANN S MD	8/27/2012	207L00000X	NA	Other	026	PHYSICIANS	105356	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	6207	42	06083	34.430526	-119.72196	Santa Barbara County
275379	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
275387	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
275424	Fee-for-Service	1891351565	1891351565	1	1	JOSEPH, AVERY DO	12/4/2024	208600000X	NA	General Surgery	026	PHYSICIANS	23247	02	General Surgery	0	In state provider	None	15965 LOS GATOS BLVD	STE 201	LOS GATOS	CA	95032	3415	43	06085	37.23642819	-121.962839	Santa Clara County
275438	Fee-for-Service	1053677823	1053677823	1	1	JOSEPH, TOM A MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129286	None	None	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
275506	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207RH0003X	NA	Oncology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
275514	Fee-for-Service	1902850894	1902850894	1	1	JEFFREY ERICKSON	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9660 S 1300 E	None	SANDY	UT	84094	3762	00	None	40.57617253	-111.8531739	Salt Lake County
275608	Fee-for-Service	1053423202	1053423202	1	1	JOHL, HARPREET MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84794	01	General Practice	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
275638	Fee-for-Service	1396972097	1396972097	1	1	JOROSZ, RENATA DO	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11363	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
275640	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
275643	Fee-for-Service	1841407665	1841407665	1	38	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General 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
275704	Fee-for-Service	1487755997	1487755997	1	1	JAMES, LEE S DC	3/18/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
275761	Fee-for-Service	1841407665	1841407665	1	78	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5201 NORRIS CANYON	140	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
275892	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
275898	Fee-for-Service	1841407665	1841407665	1	80	JOHN MUIR PHYSICIAN NETWORK	1/5/2022	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	100 WIGET	290	WALNUT CREEK	CA	94598	5988	07	06013	37.92514495	-122.0237725	Contra Costa County
275918	Fee-for-Service	1699871467	1699871467	1	1	JITPAKDEE, SASITHORN MD	6/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38940	40	Pediatrics	0	In state provider	None	2509 W MCFADDEN AVE	STE C	SANTA ANA	CA	92704	2747	30	06059	33.73454547	-117.9030645	Orange County
276050	Fee-for-Service	1003867359	1003867359	1	1	JARKA, ROBERT M MD	4/30/1988	207LP2900X	NA	Other	026	PHYSICIANS	58489	05	Anesthesiology	0	In state provider	None	MARSHALL WAY	None	PLACERVILLE	CA	95667	0000	09	06017	38.72587744	-120.791388	El Dorado County
276148	Fee-for-Service	1841407665	1841407665	1	36	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 120B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
276164	Fee-for-Service	1619263159	1619263159	1	1	JANJUNG, TENZIN	4/25/2024	207R00000X	NA	Other	026	PHYSICIANS	158467	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
276171	Fee-for-Service	1699871467	1699871467	1	1	JITPAKDEE, SASITHORN MD	6/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38940	08	Family Practice	0	In state provider	None	2509 W MCFADDEN AVE	STE C	SANTA ANA	CA	92704	2747	30	06059	33.73454547	-117.9030645	Orange County
276227	Fee-for-Service	1073565792	1073565792	1	1	JOHNSON, JOHN OLIVER MD	9/25/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	59632	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
276321	Fee-for-Service	1487177879	1487177879	1	1	JEONG, SUE N LMFT	4/1/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	236 W MOUNTAIN ST	202 E	PASADENA	CA	91103	2969	19	06037	34.16208583	-118.1575006	Los Angeles County
276439	Fee-for-Service	1295829109	1295829109	1	1	JWCH INSTITUTE, INC	9/6/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	BELL GARDENS COMM HEALTH	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	19	06037	33.96992365	-118.1629712	Los Angeles County
276503	Fee-for-Service	1669818597	1669818597	1	1	JIN, MICHAEL Y MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129172	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
276520	Fee-for-Service	1104952340	1104952340	1	1	JAMES, CHERYL T LCSW	12/8/2023	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
276569	Fee-for-Service	1831126879	1831126879	1	1	JONES, DANIELLE N 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
276589	Fee-for-Service	1730475690	1730475690	1	1	JAMBOR, NANCY-ANN K LMFT	5/20/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122996	-	NOT APPLICABLE	0	In state provider	None	805 4TH STREET	101	PASO ROBLES	CA	93446	3173	40	06079	35.61855226	-120.6891793	San Luis Obispo County
276607	Fee-for-Service	1548577869	1548577869	1	1	JOHNSON, MATTHEW J LMFT	6/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 TOM BELL RD	C	MURPHYS	CA	95247	9585	05	06009	38.13895345	-120.4557649	Calaveras County
276686	Fee-for-Service	1295829109	1295829109	1	1	JWCH INSTITUTE, INC	9/6/2005	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	BELL GARDENS COMM HEALTH	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	19	06037	33.96992365	-118.1629712	Los Angeles County
276709	Fee-for-Service	1477892347	1477892347	1	1	JAMISON, RYAN W DO INC	4/2/2013	207L00000X	NA	Other	026	PHYSICIANS	10344	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
276742	Fee-for-Service	1790875466	1790875466	1	1	JONES & JONES MEDICAL ASSOCI	7/21/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ATES INC.	18660 OUTER HWY 18	None	APPLE VALLEY	CA	92307	2316	36	06071	34.53882192	-117.2572076	San Bernardino County
276852	Fee-for-Service	1811271687	1811271687	1	1	JASA, ADAM D	11/16/2011	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
277032	Fee-for-Service	1205895331	1205895331	1	1	JAMES MICHAEL WAGNER, 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
277181	Fee-for-Service	1538622964	1538622964	1	1	JAMES, ALANNA E MD	7/18/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177485	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 2500	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
277193	Fee-for-Service	1437850179	1437850179	1	1	JONES, ELIZABETH BROADDRICK	3/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	41830 PIONEER ST	None	MURRIETA	CA	92562	2245	33	06065	33.57591896	-117.2326295	Riverside County
277238	Fee-for-Service	1497203095	1497203095	1	1	JORDAN, XIOMARA M LCSW	3/22/2022	101YP2500X	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
277247	Fee-for-Service	1215962782	1215962782	1	1	JOHN MUIR HEALTH	4/3/2000	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2740 GRANT ST	None	CONCORD	CA	94520	2265	07	06013	37.98580944	-122.0385574	Contra Costa County
277252	Fee-for-Service	1760495535	1760495535	1	1	JOLLY, JAMES J CNP	6/21/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	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
277312	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
277351	Fee-for-Service	1932268687	1932268687	1	1	JANCIS, ERIK M MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67758	68	Hematology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
277438	Fee-for-Service	1437850179	1437850179	1	1	JONES, ELIZABETH BROADDRICK	3/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	41830 PIONEER ST	None	MURRIETA	CA	92562	2245	33	06065	33.57591896	-117.2326295	Riverside County
277524	Fee-for-Service	1275536732	1275536732	1	1	JHA GERIATRIC SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 315	ENCINO	CA	91316	1519	19	06037	34.18620241	-118.5011527	Los Angeles County
277560	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
277593	Fee-for-Service	1699797027	1699797027	1	1	JOSEPHSON, VALERIE MD	5/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63482	40	Pediatrics	0	In state provider	None	1154 FREMONT BLVD	None	SEASIDE	CA	93955	5715	27	06053	36.60171959	-121.8489919	Monterey County
277594	Fee-for-Service	1932268687	1932268687	1	1	JANCIS, ERIK M MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67758	78	Neoplastic Diseases/Oncology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
277709	Fee-for-Service	1275574196	1275574196	1	1	JANKE, CIFFORD O. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
277769	Fee-for-Service	1275536732	1275536732	1	1	JHA GERIATRIC SERVICES INC	9/1/2004	315D00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 315	ENCINO	CA	91316	1519	19	06037	34.18620241	-118.5011527	Los Angeles County
277801	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
277819	Fee-for-Service	1871260158	1871260158	1	1	JD MEDICAL TRANSPORTATION	8/30/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	699 N ARROWHEAD AVE	STE 116	SAN BERNARDINO	CA	92401	1143	36	06071	34.111629	-117.289624	San Bernardino County
277853	Fee-for-Service	1275700999	1275700999	1	1	JAFFRAY, PAUL M MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128541	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
277904	Fee-for-Service	1003474859	1003474859	1	2	JOHNSON, VIVIAN E LMFT	3/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
277984	Fee-for-Service	1336227404	1336227404	1	1	JAMISON, THOMAS H MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	27534	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
277987	Fee-for-Service	1891804076	1891804076	1	1	JOSPEH, MARIES MD	2/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93682	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
278047	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
278125	Fee-for-Service	1548656937	1548656937	1	1	JACKSON, MARKUS MD	7/24/2020	207L00000X	NA	Other	026	PHYSICIANS	165519	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
278212	Fee-for-Service	1396361515	1396361515	1	1	JORDAN, LOURIE M NP	2/16/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
278225	Fee-for-Service	1447269303	1447269303	1	1	JOHN MUIR MEDICAL CENTER	8/10/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK CAMPUS	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
278237	Fee-for-Service	1760242424	1760242424	1	2	JOERNS HEALTHCARE LLC	4/25/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2635 PARK CENTER DR	SUITE C	SIMI VALLEY	CA	93065	6243	56	06111	34.28353949	-118.7974519	Ventura County
278275	Fee-for-Service	1962898254	1962898254	1	1	JOHNSON, MARIE DO	10/31/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	15109	None	None	0	In state provider	None	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
278284	Fee-for-Service	1508929266	1508929266	1	1	JOYCE, KAREN F. APN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 N WASHINGTON AVE	STE 202	COOKEVILLE	TN	38501	2660	00	None	36.16646434	-85.49861727	Putnam County
278287	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	3/2/2022	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
278309	Fee-for-Service	1609861566	1609861566	1	1	JAMAL ATALLA M.D.	6/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 W BETHANY HOME RD	None	PHOENIX	AZ	85015	2443	00	None	33.525405	-112.102461	Maricopa County
278361	Fee-for-Service	1205907128	1205907128	1	1	JEFFERS, BADI D DO	8/1/1998	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	6717	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
278368	Fee-for-Service	1750398020	1750398020	1	1	JAIN, VIVEK MD	11/1/2000	207R00000X	NA	Other	026	PHYSICIANS	69306	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
278523	Fee-for-Service	1477217966	1477217966	1	1	JIMENEZ, ULYSSES R PT	2/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12411 POWAY RD	STE 202B	POWAY	CA	92064	4302	37	06073	32.95170468	-117.0621893	San Diego County
278528	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
278612	Fee-for-Service	1164640744	1164640744	1	1	JIANG, TIAN MD	11/21/2024	207L00000X	NA	Other	026	PHYSICIANS	99136	05	Anesthesiology	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
278614	Fee-for-Service	1730182478	1730182478	1	2	JOHN FITZGIBBON MEMORIAL HOS	11/11/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2305 S 65 HIGHWAY	None	MARSHALL	MO	65340	3702	00	None	39.090222	-93.214935	Saline County
278716	Fee-for-Service	1750006268	1750006268	1	1	JARAMILLO, REBEKKAH P	5/24/2023	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
278744	Fee-for-Service	1548586423	1548586423	1	1	JENSEN, NEIL E MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142621	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
278768	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
278822	Fee-for-Service	1265537765	1265537765	1	1	JUNG, MARY S MD INC	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73312	41	Internal Medicine	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
278841	Fee-for-Service	1649748369	1649748369	1	1	JENKINS, KARA E PT	12/14/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1519 W YOSEMITE AVE	None	MANTECA	CA	95337	5159	39	06077	37.79738017	-121.2413628	San Joaquin County
278846	Fee-for-Service	1740093079	1740093079	1	1	JORDAN FOSTER PSYCHOTHERAPY	1/30/2025	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INC	2715 PORTER ST	204	SOQUEL	CA	95073	2437	44	06087	36.986121	-121.9574065	Santa Cruz County
278851	Fee-for-Service	1730182478	1730182478	1	2	JOHN FITZGIBBON MEMORIAL HOS	11/11/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2305 S 65 HIGHWAY	None	MARSHALL	MO	65340	3702	00	None	39.090222	-93.214935	Saline County
278943	Fee-for-Service	1396079935	1396079935	1	1	JOSHI, BISWAS MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119568	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
278956	Fee-for-Service	1649227935	1649227935	1	1	JEFFRY AILES, M.D	11/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7601 PIONEERS BLVD	None	LINCOLN	NE	68506	4675	00	None	40.76963969	-96.61649495	Lancaster County
278987	Fee-for-Service	1225197395	1225197395	1	1	JOE, MICHAEL	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	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
279001	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	7/25/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
279041	Fee-for-Service	1972597037	1972597037	1	1	JAMES VINCENT NERPOLA MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
279179	Fee-for-Service	1790172104	1790172104	1	1	JERI YVONNE MOVEMENT DISORDE	6/2/2021	261Q00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	RS NEUROLOGY	8327 BRIMHALL ROAD	SUITE 703	BAKERSFIELD	CA	93312	4048	15	06029	35.36876659	-119.0959355	Kern County
279199	Fee-for-Service	1962631903	1962631903	1	1	JOHNSON, KENT R MD	1/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65573	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
279225	Fee-for-Service	1699483230	1699483230	1	1	J & L INC	3/22/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12117 SATICOY ST	None	NORTH HOLLYWOOD	CA	91605	3025	19	06037	34.20850153	-118.3975153	Los Angeles County
279237	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
279399	Fee-for-Service	1003474859	1003474859	1	1	JOHNSON, VIVIAN E LMFT	3/24/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	123948	-	NOT APPLICABLE	0	In state provider	None	290 E VERDUGO AVE	STE 105	BURBANK	CA	91502	1331	19	06037	34.17971605	-118.3045891	Los Angeles County
279443	Fee-for-Service	1356429070	1356429070	1	1	JOVES, JOJO E MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51197	41	Internal Medicine	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
279469	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
279495	Fee-for-Service	1699312579	1699312579	1	1	JANETS ENTERPRISE INC	5/13/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6781 CHERIMOYA AVE	None	FONTANA	CA	92336	1313	36	06071	34.13083601	-117.4547311	San Bernardino County
279569	Fee-for-Service	1083705198	1083705198	1	1	JENNIFERWEHBERG,MD	10/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1415 WESLEY DR	None	SALISBURY	MD	21801	7130	00	None	38.33999054	-75.60810222	Wicomico County
279627	Fee-for-Service	1932298080	1932298080	1	1	JILL L JENKINS, 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	903 S ADAMS ST	None	RITZVILLE	WA	99169	2227	00	None	47.12103402	-118.3723179	Adams County
279704	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
279761	Fee-for-Service	1578528733	1578528733	1	1	JUN, IRENE H MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87966	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
279836	Fee-for-Service	1225184153	1225184153	1	1	JEAN CHENG, MD, INC	9/20/2010	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY CTR OF RIVERSIDE	8990 GARFIELD ST	STE 1	RIVERSIDE	CA	92503	3922	33	06065	33.92882844	-117.4396777	Riverside County
279887	Fee-for-Service	1669444246	1669444246	1	2	JALALZAI, WAHEED MD	6/4/2018	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
279919	Fee-for-Service	1114386018	1114386018	1	1	JOHNSON, KRYSTAL M LCSW	9/22/2023	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
279933	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
280092	Fee-for-Service	1992953475	1992953475	1	1	JONES-PISTOL, SHEREE L LMFT	9/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9003 RESEDA BLVD	STE 206	NORTHRIDGE	CA	91324	3920	19	06037	34.233885	-118.5360995	Los Angeles County
280158	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	9/10/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
280182	Fee-for-Service	1013595131	1013595131	1	1	JALALA, ZOHRA DPM	10/21/2024	213ES0103X	NA	Other	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
280241	Fee-for-Service	1396896841	1396896841	1	1	JURUPA UNIFIED SCH DIST	8/13/2001	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	4850 PEDLEY RD	None	JURUPA VALLEY	CA	92509	3966	33	06065	34.0005919	-117.4753694	Riverside County
280308	Fee-for-Service	1003132234	1003132234	1	1	JONAS, NICHOLAS N MD	5/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126512	13	Neurology (M.D. only)	0	In state provider	None	101 E BEVERLY BLVD	STE 206	MONTEBELLO	CA	90640	4300	19	06037	34.01556395	-118.0983878	Los Angeles County
280388	Fee-for-Service	1841407665	1841407665	1	13	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
280406	Fee-for-Service	1447284344	1447284344	1	1	JOHANSSON, JAN O MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	46646	18	Ophthalmology	0	In state provider	None	2809 OLIVE HWY	STE 140	OROVILLE	CA	95966	6132	04	06007	39.50386798	-121.5410203	Butte County
280500	Fee-for-Service	1588872303	1588872303	1	1	JOSEPH SOONHOW TAN, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
280608	Fee-for-Service	1841407665	1841407665	1	2	JOHN MUIR PHYSICIAN NETWORK	5/3/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
280754	Fee-for-Service	1366639031	1366639031	1	1	JANI, PUSHAN P MD	8/26/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
280779	Fee-for-Service	1396729158	1396729158	1	1	JOSEPH, PETER MD	4/30/1982	207P00000X	NA	Other	026	PHYSICIANS	35591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
280805	Fee-for-Service	1023168358	1023168358	1	1	JACQUELYN BLACKSTONE	3/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
280962	Fee-for-Service	1598085847	1598085847	1	1	JOHNSON, KATHRYN R MD	7/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128684	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
280973	Fee-for-Service	1407008097	1407008097	1	1	JETTE, CHRISTINE G MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109629	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
281188	Fee-for-Service	1912010323	1912010323	1	1	JOHN G. QUIGLEY MD	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 W TAYLOR ST	None	CHICAGO	IL	60612	7232	00	None	41.8692353	-87.67061005	Cook County
281270	Fee-for-Service	1659600534	1659600534	1	1	JIMENEZ, SERGIO E	4/4/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
281292	Fee-for-Service	1417207358	1417207358	1	1	JAFARI, PAYAM PSYD	3/6/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23 CORPORATE PLAZA DR ST	None	NEWPORT BEACH	CA	92660	7908	30	06059	33.6090297	-117.8748261	Orange County
281356	Fee-for-Service	1639533938	1639533938	1	1	JARYN L. WARREN, MARRIAGE AN	12/4/2020	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	R	2501 W. SHAW AVE	STE 119	FRESNO	CA	93710	7510	10	06019	36.8064869	-119.8354798	Fresno County
281458	Fee-for-Service	1295856227	1295856227	1	1	JOHN, SAJI T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52030	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
281483	Fee-for-Service	1487901583	1487901583	1	1	JEFFREY DEAN SMITH	2/1/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1782 W COLUMBIA WAY	None	HANFORD	CA	93230	1104	16	06031	36.3332979	-119.6745181	Kings County
281529	Fee-for-Service	1568540367	1568540367	1	1	JENNIS, MICHAEL S MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	47237	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
281570	Fee-for-Service	1639533938	1639533938	1	1	JARYN L. WARREN, MARRIAGE AN	10/23/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	R	2501 W. SHAW AVE	STE 119	FRESNO	CA	93710	7510	10	06019	36.8064869	-119.8354798	Fresno County
281598	Fee-for-Service	1356792931	1356792931	1	1	JANSSEN, CLAIRE MD	3/13/2025	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	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
281621	Fee-for-Service	1558317370	1558317370	1	1	JOHNSON, BRIAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35725	30	Radiology	0	In state provider	None	88 N SAN MATEO DR	None	SAN MATEO	CA	94401	2824	41	06081	37.56804187	-122.3278806	San Mateo County
281642	Fee-for-Service	1295813954	1295813954	1	1	JAKI, KAI A MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55121	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
281684	Fee-for-Service	1588841712	1588841712	1	1	JEWELL, MEGAN F MD	7/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101586	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2999 REGENT ST	#301	BERKELEY	CA	94705	2118	01	06001	37.85592021	-122.2566436	Alameda County
281696	Fee-for-Service	1487901583	1487901583	1	1	JEFFREY DEAN SMITH	2/1/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1782 W COLUMBIA WAY	None	HANFORD	CA	93230	1104	16	06031	36.3332979	-119.6745181	Kings County
281911	Fee-for-Service	1821184763	1821184763	1	1	JUDD, KATHLEEN M MD	2/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	80764	41	Internal Medicine	0	In state provider	None	230 2ND STREET	SUITE 102	ENCINITAS	CA	92024	3275	37	06073	33.04922461	-117.2952948	San Diego County
281971	Fee-for-Service	1730497421	1730497421	1	1	JASBIR S KANG MD AND SANJIV	6/1/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MIDHA MD A MEDICAL CORP	527 E STREET	None	MARYSVILLE	CA	95901	5529	58	06115	39.14098899	-121.5905578	Yuba County
282015	Fee-for-Service	1104972207	1104972207	1	1	JONES,JASON P MD	10/28/2008	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
282067	Fee-for-Service	1457448755	1457448755	1	1	JENNIE EDMUNDSON MEM HOS	3/29/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	933 E PIERCE ST	None	COUNCIL BLUFFS	IA	51503	4652	00	None	41.26884745	-95.83553373	Pottawattamie County
282115	Fee-for-Service	1821184763	1821184763	1	1	JUDD, KATHLEEN M MD	2/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	80764	83	Rheumatology	0	In state provider	None	230 2ND STREET	SUITE 102	ENCINITAS	CA	92024	3275	37	06073	33.04922461	-117.2952948	San Diego County
282176	Fee-for-Service	1730497421	1730497421	1	1	JASBIR S KANG MD AND SANJIV	7/11/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MIDHA MD A MEDICAL CORP	527 E STREET	None	MARYSVILLE	CA	95901	5529	58	06115	39.14098899	-121.5905578	Yuba County
282203	Fee-for-Service	1033471115	1033471115	1	1	JUSTIN RECKARD MD INC	5/17/2020	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	71943 HIGHWAY 111	None	RANCHO MIRAGE	CA	92270	4848	33	06065	33.73726724	-116.4092742	Riverside County
282275	Fee-for-Service	1457448755	1457448755	1	1	JENNIE EDMUNDSON MEM HOS	3/29/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	933 E PIERCE ST	None	COUNCIL BLUFFS	IA	51503	4652	00	None	41.26884745	-95.83553373	Pottawattamie County
282343	Fee-for-Service	1780357400	1780357400	1	1	JAIME, ANGELA LPCC	8/2/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2549 W SHAW AVE	None	FRESNO	CA	93711	3308	10	06019	36.80803919	-119.838887	Fresno County
282382	Fee-for-Service	1730497421	1730497421	1	1	JASBIR S KANG MD AND SANJIV	7/11/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MIDHA MD A MEDICAL CORP	527 E STREET	None	MARYSVILLE	CA	95901	5529	58	06115	39.14098899	-121.5905578	Yuba County
282400	Fee-for-Service	1013909498	1013909498	1	1	JOSEPH, SONIA R DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14353	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
282407	Fee-for-Service	1407112568	1407112568	1	1	JALLURI, CHRISTINE J MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139261	01	General Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
282465	Fee-for-Service	1427038736	1427038736	1	1	JINDAL, PRATEEK DO	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8647	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
282574	Fee-for-Service	1427775592	1427775592	1	1	JOSE A AGUIRRE MD PC SILVER	7/23/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	235 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
282628	Fee-for-Service	1972894699	1972894699	1	1	JENSEN, STEPHANIE E CRNA	2/7/2012	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
282671	Fee-for-Service	1750370714	1750370714	1	1	JIMMY CHING-MAN LEUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9003 E SHEA BLVD	None	SCOTTSDALE	AZ	85260	6709	00	None	33.580377	-111.88548	Maricopa County
282915	Fee-for-Service	1255348199	1255348199	1	1	JORDAN, JOHN 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	3901 HOYT AVE	None	EVERETT	WA	98201	4918	00	None	47.9655876	-122.2094249	Snohomish County
282960	Fee-for-Service	1962405266	1962405266	1	1	JAVADI, NADER MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	67700	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
283017	Fee-for-Service	1942262464	1942262464	1	1	JOHNSON, LEE M MD	2/1/2022	207P00000X	NA	Other	026	PHYSICIANS	172116	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
283025	Fee-for-Service	1457374662	1457374662	1	1	JOHNSON, BRETT L MD	3/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81395	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
283125	Fee-for-Service	1750407318	1750407318	1	1	JUNG, ANDRE S MD	6/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87334	78	Neoplastic Diseases/Oncology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
283155	Fee-for-Service	1962405266	1962405266	1	1	JAVADI, NADER MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	67700	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
283169	Fee-for-Service	1629391305	1629391305	1	1	JORDAN, TAYLOR R MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97803	None	None	0	In state provider	None	400 PARNASSUS AVENUE	0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
283194	Fee-for-Service	1033110549	1033110549	1	1	JAMES HEISEL	3/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	205 N EAST AVE	None	JACKSON	MI	49201	1753	00	None	42.25035275	-84.39360669	Jackson County
283316	Fee-for-Service	1750407318	1750407318	1	1	JUNG, ANDRE S MD	6/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87334	68	Hematology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
283345	Fee-for-Service	1962405266	1962405266	1	1	JAVADI, NADER MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	67700	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
283358	Fee-for-Service	1285674341	1285674341	1	1	JAMES T MAJORS	3/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	407 14TH AVE SE	None	PUYALLUP	WA	98372	3770	00	None	47.17876904	-122.2882465	Pierce County
283364	Fee-for-Service	1720051881	1720051881	1	1	JUNG, GEORGE Q MD	2/10/1995	207R00000X	NA	Other	026	PHYSICIANS	51541	41	Internal Medicine	0	In state provider	None	960 E GREEN ST	STE 208	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
283535	Fee-for-Service	1720077662	1720077662	1	1	JOSE, PAULINE J MD	11/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75388	08	Family Practice	0	In state provider	None	5901 W OLYMPIC BLVD	STE 504	LOS ANGELES	CA	90036	4633	19	06037	34.05764121	-118.3603115	Los Angeles County
283612	Fee-for-Service	1790808400	1790808400	1	1	JAMES, MARSTON MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	35270	-	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
283664	Fee-for-Service	1750486189	1750486189	1	1	JAIN, SHARAD MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	78997	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
283715	Fee-for-Service	1225265663	1225265663	1	1	JONATHAN AARON ROMASH M.D.	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	736 BATTLEFIELD BLVD N	None	CHESAPEAKE	VA	23320	4941	00	None	36.74619744	-76.24489616	Chesapeake city
283758	Fee-for-Service	1215467592	1215467592	1	1	JOSEPH, NOEL MD	8/1/2023	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
283759	Fee-for-Service	1942261755	1942261755	1	1	JOHN F. POHL M.D.	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
283896	Fee-for-Service	1649805912	1649805912	1	1	JINGMA INC	2/12/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	34909 OSPREY DR	None	UNION CITY	CA	94587	4618	01	06001	37.58249355	-122.015346	Alameda County
283927	Fee-for-Service	1629605746	1629605746	1	1	JACKSON, RENAE MD	8/1/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
284091	Fee-for-Service	1982762365	1982762365	1	1	JAMSHIDI, JAVAD MD	2/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	32321	30	Radiology	0	In state provider	None	2320 N CALIFORNIA ST	STE 2	STOCKTON	CA	95204	5509	39	06077	37.97483792	-121.2907554	San Joaquin County
284114	Fee-for-Service	1629605746	1629605746	1	1	JACKSON, RENAE MD	8/1/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
284122	Fee-for-Service	1902199821	1902199821	1	1	JOHNSON, JESSICA A LM	4/13/2016	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1608 SUNRISE AVE	SUITE A	MODESTO	CA	95350	4678	50	06099	37.66782938	-120.9848364	Stanislaus County
284208	Fee-for-Service	1306879325	1306879325	1	1	JICHA, DOUGLAS L MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76380	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
284267	Fee-for-Service	1154399988	1154399988	1	1	JANNETTE COLLINS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
284353	Fee-for-Service	1730213794	1730213794	1	1	JANUS OF SANTA CRUZ	8/17/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1000A,1010C EMELINE AV	None	SANTA CRUZ	CA	95060	1900	44	06087	36.99143888	-122.0175948	Santa Cruz County
284407	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	11/16/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
284410	Fee-for-Service	1588157481	1588157481	1	1	JOHNSON, MATTHEW A DO	9/1/2022	207L00000X	NA	Other	026	PHYSICIANS	19598	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
284419	Fee-for-Service	1689329799	1689329799	1	1	JOHNSON, MADELINE	8/11/2022	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
284508	Fee-for-Service	1861613267	1861613267	1	1	JILANI, SHEBA MD	11/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98418	25	Physical Medicine and Rehabilitation	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
284524	Fee-for-Service	1730213794	1730213794	1	1	JANUS OF SANTA CRUZ	10/1/2004	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1000A,1010C EMELINE AV	None	SANTA CRUZ	CA	95060	1900	44	06087	36.99143888	-122.0175948	Santa Cruz County
284538	Fee-for-Service	1376749739	1376749739	1	1	JARINA, AILEEN A	11/10/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
284552	Fee-for-Service	1255303962	1255303962	1	1	JAMES, JOHN T DO	7/1/1997	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	MEDICAL DIAGNOSTIC IM	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
284577	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	1/11/2022	208D00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
284593	Fee-for-Service	1285766006	1285766006	1	1	JUNG, ALEXANDER S MD	3/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85944	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
284619	Fee-for-Service	1689098618	1689098618	1	1	JARRETT-ETONYE, CODETH	9/24/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
284634	Fee-for-Service	1013930932	1013930932	1	1	JAMES M FREER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	None	SAINT LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
284647	Fee-for-Service	1982736757	1982736757	1	1	JAYNETTE MILLER	3/16/2021	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	535 S FREEBORN ST	None	MARION	KS	66861	1256	00	None	38.34285096	-97.01000785	Marion County
284683	Fee-for-Service	1164629390	1164629390	1	1	JHUN, PAUL S MD	11/29/2010	207P00000X	NA	Other	026	PHYSICIANS	105961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
284699	Fee-for-Service	1922398429	1922398429	1	1	JONSSON, ARINBJORN MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152305	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
284717	Fee-for-Service	1932266798	1932266798	1	1	JANG, JOHNNY Y OD	2/22/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
284747	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	10/24/2022	208D00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
284748	Fee-for-Service	1760687974	1760687974	1	1	JAMES HOFFMAN	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
284775	Fee-for-Service	1326076563	1326076563	1	1	JOHNSON, NANCY A LMFT	3/28/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31441	-	NOT APPLICABLE	0	In state provider	None	105 N LINCOLN ST	None	SANTA MARIA	CA	93458	4319	42	06083	34.9535882	-120.4374049	Santa Barbara County
284784	Fee-for-Service	1649279944	1649279944	1	1	JAMES MARTINEZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SW GASTROENTEROLOGY	7788 JEFFERSON NE	None	ALBUQUERQUE	NM	87109	0000	00	None	35.17051067	-106.5890655	Bernalillo County
284912	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	11/16/2020	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
284914	Fee-for-Service	1881013787	1881013787	1	1	JENSEN, ALEXANDRA C	5/27/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
284930	Fee-for-Service	1225374564	1225374564	1	2	JURUPA VALLEY PHARMACY INC	7/4/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7830 - 7832 LIMONITE AVE	None	JURUPA VALLEY	CA	92509	5360	33	06065	33.97840293	-117.4535293	Riverside County
285006	Fee-for-Service	1184104085	1184104085	1	1	JOYCE MARRIAGE FAMILY AND CH	3/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	473 E CARNEGIE DR	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
285077	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	11/16/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
285093	Fee-for-Service	1467042556	1467042556	1	1	JOHN MUIR CHARTER SCHOOLS	4/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	117 NEW MOHAWK RD	SUITE F	NEVADA CITY	CA	95959	3227	29	06057	39.24878207	-121.0165833	Nevada County
285117	Fee-for-Service	1821068149	1821068149	1	1	JUNG, BARBARA L OD	10/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1080 S WHITE RD	STE A	SAN JOSE	CA	95127	3821	43	06085	37.35796288	-121.8207543	Santa Clara County
285153	Fee-for-Service	1083725196	1083725196	1	1	JENSEN, STEVEN MD	10/31/1985	2080P0203X	NA	Other	026	PHYSICIANS	42543	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
285194	Fee-for-Service	1861842932	1861842932	1	1	JONES, GARRETT C	4/18/2022	208600000X	NA	General Surgery	026	PHYSICIANS	16205	None	None	0	In state provider	None	300 HILLMONT AVE STE 401	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
285239	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	1/22/2024	208D00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
285248	Fee-for-Service	1831121607	1831121607	1	1	JORDAN, MARK L MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127775	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
285310	Fee-for-Service	1487668703	1487668703	1	1	JOW, KAMI K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61046	40	Pediatrics	0	In state provider	None	12675 LA MIRADA BLVD	STE 300	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
285320	Fee-for-Service	1245370717	1245370717	1	1	JAMAICA HOSPITAL	4/20/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
285397	Fee-for-Service	1851369847	1851369847	1	1	JAIN, SHILPA H MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107201	67	Endocrinology	0	In state provider	None	1375 SUTTER ST	SUITE 208	SAN FRANCISCO	CA	94109	4869	38	06075	37.78738239	-122.4229066	San Francisco County
285402	Fee-for-Service	1841407665	1841407665	1	71	JOHN MUIR PHYSICIAN NETWORK	2/10/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	122 LA CASA	120	WALNUT CREEK	CA	94598	3052	07	06013	37.91198028	-122.041845	Contra Costa County
285451	Fee-for-Service	1417122086	1417122086	1	1	JO, GRETA S MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147242	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.715035	-117.936993	Orange County
285469	Fee-for-Service	1487668703	1487668703	1	1	JOW, KAMI K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61046	08	Family Practice	0	In state provider	None	12675 LA MIRADA BLVD	STE 300	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
285477	Fee-for-Service	1245370717	1245370717	1	1	JAMAICA HOSPITAL	6/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
285480	Fee-for-Service	1437318946	1437318946	1	1	JOSHI, NEEL R MD	10/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87694	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
285496	Fee-for-Service	1255745980	1255745980	1	1	JACKSON, JENNIFER L MD	10/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144649	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
285622	Fee-for-Service	1932289493	1932289493	1	1	JUNG, WAYMOND J MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	66521	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
285635	Fee-for-Service	1184680258	1184680258	1	1	JACOBS, BRADLY P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
285729	Fee-for-Service	1376572776	1376572776	1	1	JOY, SUSAN M MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140570	01	General Practice	0	In state provider	None	1 SPORTS PARKWAY	None	SACRAMENTO	CA	95834	2300	34	06067	38.647908	-121.5170955	Sacramento County
285788	Fee-for-Service	1184680258	1184680258	1	1	JACOBS, BRADLY P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60433	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
285792	Fee-for-Service	1346444577	1346444577	1	1	JAIN, RASHMI MD	5/27/2013	207R00000X	NA	Other	026	PHYSICIANS	42911	45	Nephrology (Renal-Kidney)	0	In state provider	None	1285 CARDIGAN RD	None	HILLSBOROUGH	CA	94010	7127	41	06081	37.55076668	-122.3555264	San Mateo County
285847	Fee-for-Service	1447658547	1447658547	1	1	JAMES, PAMELA NSOROMA A LCSW	1/15/2024	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
286113	Fee-for-Service	1649288564	1649288564	1	1	JENSEN, STANLEY D DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3687 LAS POSAS RD	STE 185	CAMARILLO	CA	93010	1431	56	06111	34.24091285	-119.0211816	Ventura County
286177	Fee-for-Service	1336253400	1336253400	1	1	JIANG, BERNARD H MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55733	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
286254	Fee-for-Service	1275928103	1275928103	1	1	JERNICK, NICOLE M C MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146091	01	General Practice	0	In state provider	None	1570 E HERNDON AVE	None	FRESNO	CA	93720	3303	10	06019	36.83756046	-119.759841	Fresno County
286409	Fee-for-Service	1982801940	1982801940	1	1	JOSE, TINA K MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117554	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
286464	Fee-for-Service	1275663197	1275663197	1	1	JARRIN, GREGORY 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	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
286517	Fee-for-Service	1205802907	1205802907	1	1	JAVEED, MANSOOR MD	3/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	49861	78	Neoplastic Diseases/Oncology	0	In state provider	None	1580 CREEKSIDE DR	STE 230	FOLSOM	CA	95630	3888	34	06067	38.668914	-121.148028	Sacramento County
286526	Fee-for-Service	1841653672	1841653672	1	1	JOEA, RAJVEER DO	8/7/2019	207R00000X	NA	Other	026	PHYSICIANS	15808	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
286529	Fee-for-Service	1710035639	1710035639	1	1	JIA, LIN ZHUO MD	12/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81092	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
286568	Fee-for-Service	1700966066	1700966066	1	1	JOHNSON, KAREN 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
286647	Fee-for-Service	1255745980	1255745980	1	2	JACKSON, JENNIFER MD	8/30/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	144649	-	NOT APPLICABLE	0	In state provider	None	9705 S HOLMES AVE	None	LOS ANGELES	CA	90002	3031	19	06037	33.94797442	-118.2408345	Los Angeles County
286661	Fee-for-Service	1205802907	1205802907	1	1	JAVEED, MANSOOR MD	3/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	49861	68	Hematology	0	In state provider	None	1580 CREEKSIDE DR	STE 230	FOLSOM	CA	95630	3888	34	06067	38.668914	-121.148028	Sacramento County
287020	Fee-for-Service	1700971769	1700971769	1	1	JAMM, LILY E MD	7/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64590	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
287043	Fee-for-Service	1154857175	1154857175	1	1	JAMES J WU MEDICAL CORPORTAI	12/21/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	CORPORTAION	1818 N ORANGE GROVE AVE	200	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
287048	Fee-for-Service	1790933398	1790933398	1	1	JONES, VALORIA D LCSW	7/12/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
287125	Fee-for-Service	1548322845	1548322845	1	1	JONES-GOCHIS, HEATHER MD	11/17/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168415	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
287135	Fee-for-Service	1730386129	1730386129	1	1	JEDLICKA, ANGELINA L	10/19/2010	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
287148	Fee-for-Service	1982070306	1982070306	1	1	JIMENEZ, ALFONSO MD	6/12/2021	208M00000X	NA	Other	026	PHYSICIANS	168159	None	None	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
287220	Fee-for-Service	1952595522	1952595522	1	1	JORDAN VALLEY AMBULANCE SVCS	3/27/2018	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	306 BLACKABY ST	None	JORDAN VALLEY	OR	97910	8013	00	None	42.974964	-117.0557815	Malheur County
287256	Fee-for-Service	1558304139	1558304139	1	1	JENSEN, GARY L MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	43613	30	Radiology	0	In state provider	CLAREMONT IMAGING ASSOC	255 E BONITA AVE	BLDG 3A	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
287307	Fee-for-Service	1760659437	1760659437	1	1	JATINDER BABBAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA STREET	None	PITTSBURGH	PA	15213	0000	00	None	40.44350017	-79.95952606	Allegheny County
287392	Fee-for-Service	1487675120	1487675120	1	1	JONES, HENRY M MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88162	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
287461	Fee-for-Service	1548545239	1548545239	1	1	J. YOO M.D. PC	4/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	408 S. BEACH BLVD	SUITE 213	ANAHEIM	CA	92804	1889	30	06059	33.82709101	-117.9932293	Orange County
287494	Fee-for-Service	1073642773	1073642773	1	1	JONES, H JAMES DO	12/18/2007	204D00000X	NA	Other	026	PHYSICIANS	6500	01	General Practice	0	In state provider	None	807 WEST 7TH STREET	None	HANFORD	CA	93230	4926	16	06031	36.3251765	-119.6571645	Kings County
287521	Fee-for-Service	1619296779	1619296779	2	1	JONES, MEGAN L MD	2/4/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164436	15	Obstetrics (D.O. only)	0	In state provider	None	2901 N VENTURA RD	SUITE 110	OXNARD	CA	93036	1150	56	06111	34.24479149	-119.1814409	Ventura County
287546	Fee-for-Service	1700177987	1700177987	1	1	JIMENEZ, CASSANDRA	10/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287588	Fee-for-Service	1497182208	1497182208	1	1	JAMIE RICHARDS D NP	11/7/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
287596	Fee-for-Service	1548545239	1548545239	1	1	J. YOO M.D. PC	4/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	408 S. BEACH BLVD	SUITE 213	ANAHEIM	CA	92804	1889	30	06059	33.82709101	-117.9932293	Orange County
287610	Fee-for-Service	1790348779	1790348779	1	1	JOHNSON, MEGHAN E MD	6/15/2022	208M00000X	NA	Other	026	PHYSICIANS	177493	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
287650	Fee-for-Service	1619296779	1619296779	2	1	JONES, MEGAN L MD	2/4/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164436	09	Gynecology (D.O. only)	0	In state provider	None	2901 N VENTURA RD	SUITE 110	OXNARD	CA	93036	1150	56	06111	34.24479149	-119.1814409	Ventura County
287730	Fee-for-Service	1326083320	1326083320	1	1	JACKSON, THOMAS W MD	3/31/1989	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	49810	20	Orthopedic Surgery	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4136	33	06065	33.97614344	-117.3797664	Riverside County
287761	Fee-for-Service	1013233105	1013233105	1	1	JOHNSON, AMANDA J MD	2/25/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	09	Gynecology (D.O. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
287921	Fee-for-Service	1568543130	1568543130	1	1	JAVED, MUNIR MD	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	49052	41	Internal Medicine	0	In state provider	None	2204 GRANT ROAD	STE 203	MOUNTAIN VIEW	CA	94040	3855	43	06085	37.37193085	-122.0779465	Santa Clara County
288031	Fee-for-Service	1487637922	1487637922	1	1	JACKSON, MICHAEL V MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	PULMONARY MEDICINE ASSOC	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
288097	Fee-for-Service	1386008563	1386008563	1	1	JOHN, AVINAJ M DO	8/26/2021	207RC0200X	NA	Other	026	PHYSICIANS	18950	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
288131	Fee-for-Service	1124009352	1124009352	1	1	JON KING	10/8/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2320 N 3RD ST	None	PHOENIX	AZ	85004	1303	00	None	33.473745	-112.0697325	Maricopa County
288149	Fee-for-Service	1487637922	1487637922	1	1	JACKSON, MICHAEL V MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	PULMONARY MEDICINE ASSOC	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
288243	Fee-for-Service	1639218514	1639218514	1	1	JOHNSON, THERESA LYNN	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3009 HUBBARD LN	STE G	EUREKA	CA	95501	4801	12	06023	40.78115142	-124.1302872	Humboldt County
288269	Fee-for-Service	1992110274	1992110274	1	1	JACKSON, CHRISTINE F OD	10/23/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	360 SIERRA COLLEGE DR	STE 100	GRASS VALLEY	CA	95945	5088	29	06057	39.23622963	-121.0549676	Nevada County
288289	Fee-for-Service	1982621488	1982621488	1	1	JOSEPH D GUNN 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
288321	Fee-for-Service	1477750602	1477750602	1	1	JAIN, SUNIL K MD	1/10/2023	208M00000X	NA	Other	026	PHYSICIANS	150187	None	None	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
288335	Fee-for-Service	1568900587	1568900587	1	1	JOWZA, REGINA F 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
288382	Fee-for-Service	1033185244	1033185244	1	1	JEHLAR, ALEXANDER MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76314	41	Internal Medicine	0	In state provider	None	2590 E MAIN ST	None	VENTURA	CA	93003	2619	56	06111	34.27490911	-119.261894	Ventura County
288521	Fee-for-Service	1144232208	1144232208	1	1	JEEGER, APIRL 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	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
288750	Fee-for-Service	1396527081	1396527081	1	1	JSOR PHARMACY INC	12/7/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18182 US HIGHWAY 18	STE 101	APPLE VALLEY	CA	92307	2200	36	06071	34.54087945	-117.267147	San Bernardino County
288786	Fee-for-Service	1972572386	1972572386	1	1	JARMAKANI, MARWAN F MD	11/6/2021	2085R0204X	NA	Other	026	PHYSICIANS	42421	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
288885	Fee-for-Service	1114346657	1114346657	1	1	JAVED, AHMED Y MD	8/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145010	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
288971	Fee-for-Service	1609052000	1609052000	1	1	JOHNSTON, SEAN K MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136738	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
289041	Fee-for-Service	1205196987	1205196987	1	1	JUDGE, STEPHEN P MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126445	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
289060	Fee-for-Service	1760242424	1760242424	1	1	JOERNS HEALTHCARE LLC	4/25/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4223 PONDEROSA AVE	SUITE B	SAN DIEGO	CA	92123	1529	37	06073	32.81652	-117.131301	San Diego County
289169	Fee-for-Service	1568466050	1568466050	1	1	JOHNSEY L. LEEF, M.D.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 KANAWHA BLVD E	None	CHARLESTON	WV	25301	2400	00	None	38.34470937	-81.63296112	Kanawha County
289316	Fee-for-Service	1205417326	1205417326	1	1	JEIROUDI, OMAR G MD	8/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191510	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
289374	Fee-for-Service	1659596856	1659596856	1	1	JANET RIOS RN QMRP	8/21/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ANITA EDELMAN MA ED	5541 SOLARI RANCH RD	None	STOCKTON	CA	95215	9318	39	06077	38.01871261	-121.229124	San Joaquin County
289379	Fee-for-Service	1427297498	1427297498	1	1	JAJCO INC	4/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ANCHOR DRUGS III	161 SOUTH SPRUCE AVE	None	S SAN FRANCISCO	CA	94080	3635	41	06081	37.64915337	-122.4185534	San Mateo County
289419	Fee-for-Service	1891754677	1891754677	1	1	JOHNSON, ALLEN D MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32373	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
289423	Fee-for-Service	1922584432	1922584432	1	1	JORDAN, ELENA MD	2/18/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	165720	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
289481	Fee-for-Service	1609993658	1609993658	1	1	JOSEPH SHERMAN	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
289505	Fee-for-Service	1619019601	1619019601	1	1	JIMENEZ, DOLORES M PHD	3/7/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	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
289506	Fee-for-Service	1891754677	1891754677	1	1	JOHNSON, ALLEN D MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32373	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
289535	Fee-for-Service	1992258685	1992258685	1	1	JOHN, JANCY CRNA	7/1/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
289610	Fee-for-Service	1154438372	1154438372	1	1	JAMSHIDI, ALI MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55436	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
289649	Fee-for-Service	1952622540	1952622540	1	1	JAMMAL, MANSOUR G MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123933	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
289753	Fee-for-Service	1063889004	1063889004	1	1	JAGIELLO, KATHERINE K LMFT	5/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
289797	Fee-for-Service	1790939502	1790939502	1	1	JEFFRY MAXWELL MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
289869	Fee-for-Service	1528011970	1528011970	1	1	JAIN, SAURABH MD	4/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96287	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
289926	Fee-for-Service	1861408502	1861408502	1	1	JACOBS, AARON 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
289990	Fee-for-Service	1720024847	1720024847	1	1	JACKSON, ANTHONY L MD	12/5/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43207	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
290039	Fee-for-Service	1376637348	1376637348	1	1	JEFFRIES, HOWARD E MD	12/1/1999	2080P0204X	NA	Other	026	PHYSICIANS	67815	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
290056	Fee-for-Service	1720024847	1720024847	1	1	JACKSON, ANTHONY L MD	12/5/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43207	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
290094	Fee-for-Service	1265876171	1265876171	1	1	JOHNSON, BRETT DO	6/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22978	38	Geriatrics	0	In state provider	None	6939 SUNRISE BLVD	STE 106	CITRUS HEIGHTS	CA	95610	3153	34	06067	38.692602	-121.2731145	Sacramento County
290097	Fee-for-Service	1619055779	1619055779	1	1	JAKSA,CHRISTOPHER J MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72559	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
290100	Fee-for-Service	1376637348	1376637348	1	1	JEFFRIES, HOWARD E MD	12/1/1999	2080P0204X	NA	Other	026	PHYSICIANS	67815	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
290151	Fee-for-Service	1265876171	1265876171	1	1	JOHNSON, BRETT DO	6/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22978	08	Family Practice	0	In state provider	None	6939 SUNRISE BLVD	STE 106	CITRUS HEIGHTS	CA	95610	3153	34	06067	38.692602	-121.2731145	Sacramento County
290174	Fee-for-Service	1730683277	1730683277	1	1	JANDU, JAGMOHAN S MD	9/28/2021	207R00000X	NA	Other	026	PHYSICIANS	174374	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
290188	Fee-for-Service	1679079073	1679079073	1	1	JOHNSTON, ALLIE E DO	6/30/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17999	None	None	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
290260	Fee-for-Service	1316069727	1316069727	2	1	JENNIFER DE GRAAUW	6/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 EXEMPLA CIR	None	LAFAYETTE	CO	80026	3370	00	None	39.97232464	-105.086171	Boulder County
290433	Fee-for-Service	1487700894	1487700894	1	1	JAFRI, ASMA B MD	9/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36753	08	Family Practice	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
290465	Fee-for-Service	1720347115	1720347115	1	1	JOA, LIANA MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134080	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
290588	Fee-for-Service	1124690656	1124690656	1	1	JOHAN, KENNETH MD	10/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
290666	Fee-for-Service	1851404263	1851404263	1	1	JOHNSON, KENNETH A MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65948	05	Anesthesiology	0	In state provider	None	3931 MACARTHUR BLVD	STE 105	NEWPORT BEACH	CA	92660	3012	30	06059	33.65770891	-117.8628645	Orange County
290712	Fee-for-Service	1942358775	1942358775	1	1	JAHAN-PARWAR BABAK MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68817	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
290732	Fee-for-Service	1700898103	1700898103	1	1	JEFFREY M. SMITH, M.D., INC.	8/29/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83625	None	None	0	In state provider	CTURE SPECIALISTS MEDICA	3750 CONVOY STREET	SUITE 201	SAN DIEGO	CA	92111	3770	37	06073	32.81201122	-117.1531108	San Diego County
290763	Fee-for-Service	1407171390	1407171390	1	1	JOLLEY, BRYCE D DPM	11/13/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
290853	Fee-for-Service	1972083459	1972083459	1	1	JB PHARMACY INC	7/9/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2777 PACIFIC AVE	STE A	LONG BEACH	CA	90806	2626	19	06037	33.80761478	-118.193744	Los Angeles County
290868	Fee-for-Service	1407242928	1407242928	1	1	JEPPSEN, SAMANTHA M MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	146569	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
290920	Fee-for-Service	1962672246	1962672246	1	1	JAMARI, DAMANPREET MD	6/17/2008	282N00000X	NA	Hospitals	026	PHYSICIANS	102185	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
291135	Fee-for-Service	1982931598	1982931598	1	1	JAWAHARALI, SHAHEEN MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109628	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
291210	Fee-for-Service	1376513168	1376513168	1	1	JASSMANN, SANDRA L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 3-360	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
291219	Fee-for-Service	1376513168	1376513168	1	1	JASSMANN, SANDRA L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27383	41	Internal Medicine	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 3-360	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
291241	Fee-for-Service	1376513168	1376513168	1	1	JASSMANN, SANDRA L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27383	67	Endocrinology	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 3-360	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
291275	Fee-for-Service	1164569661	1164569661	1	1	JOHANNA L MCCULLAGH MD	3/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2214 CANTERBURY DR	STE 200	HAYS	KS	67601	2375	00	None	38.879892	-99.2960775	Ellis County
291401	Fee-for-Service	1154874279	1154874279	1	1	JORDAN, ALISON H CCC-SLP	9/19/2024	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
291449	Fee-for-Service	1740839604	1740839604	1	1	JOSHUA LAWRENCE TYLER	9/19/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1168 ASPEN LN	None	BANNING	CA	92220	1402	33	06065	33.93586347	-116.9154159	Riverside County
291454	Fee-for-Service	1740839604	1740839604	1	1	JOSHUA LAWRENCE TYLER	9/19/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1168 ASPEN LN	None	BANNING	CA	92220	1402	33	06065	33.93586347	-116.9154159	Riverside County
291479	Fee-for-Service	1598151433	1598151433	1	1	JOSHI, YASH MD	4/22/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147156	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
291540	Non-Physician Medical Practitioner	None	1760174916	0	0	JANG, JI SOON NP	8/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
291564	Non-Physician Medical Practitioner	None	1962553628	0	0	JOHNSON, IVY M PA-C	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	1440 N HARBOR BLVD	STE 100	FULLERTON	CA	92835	4127	00	06000	33.88513341	-117.926041	Orange County
291586	Non-Physician Medical Practitioner	None	1811481542	0	0	JENNINGS, MELISSA NP	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	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
291638	Non-Physician Medical Practitioner	None	1497486757	0	0	JOHNSON, SHANNON 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	2 GOVERNORS LN	SUITE A	CHICO	CA	95926	6300	00	06000	39.75567003	-121.8588553	Butte County
291653	Non-Physician Medical Practitioner	None	1003560962	0	0	JUSAY, ISABELLA NP	3/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
291656	Non-Physician Medical Practitioner	None	1811513021	0	0	JOHNSON, GABRIELLE C NP	12/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	00	06000	34.06269295	-118.2030006	Los Angeles County
291689	Non-Physician Medical Practitioner	None	1811095813	0	0	JOHANSON, JANET S	5/18/2004	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
291868	Non-Physician Medical Practitioner	None	1366841355	0	0	JULIEN, CLARA E NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1114 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63901905	-121.0057149	Stanislaus County
291902	Non-Physician Medical Practitioner	None	1902469364	0	0	JOHNK, DORIEN A 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	18 BON AIR RD	None	LARKSPUR	CA	94939	1123	00	06000	37.94413684	-122.5391261	Marin County
291921	Non-Physician Medical Practitioner	None	1255972436	0	0	JIMENEZ, BRIAN PA	1/4/2021	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
291956	Non-Physician Medical Practitioner	None	1972588754	0	0	JONES, MARION W	8/1/1998	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	OB/GYN, #2500, ACC	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
292072	Non-Physician Medical Practitioner	None	1366050197	0	0	JEONG, JENNIFER K NP	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	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
292081	Non-Physician Medical Practitioner	None	1124082292	0	0	JOHNSON, BLAIR R	9/4/1984	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 W ROWLAND ST	None	COVINA	CA	91723	2943	00	06000	34.078949	-117.8963031	Los Angeles County
292095	Non-Physician Medical Practitioner	None	1508269192	0	0	JOHNSTON, BRIAN D	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	3517 S BASCOM	None	CAMPBELL	CA	95008	7066	00	06000	37.26219809	-121.9447348	Santa Clara County
292131	Non-Physician Medical Practitioner	None	1356715189	0	0	JONES, KATHERINE PA	7/31/2019	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
292175	Non-Physician Medical Practitioner	None	1255682373	0	0	JO, ISA NP	2/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32770 OLD WOMAN SPRINGS	UNIT A	LUCERNE VALLEY	CA	92356	7012	00	06000	34.44391545	-116.948943	San Bernardino County
292197	Non-Physician Medical Practitioner	None	1932760857	0	0	JACINTO, SAMANTHA PA	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	5630 SANTA ANA CANYON	None	ANAHEIM	CA	92807	3122	00	06000	33.85124385	-117.7915652	Orange County
292411	Non-Physician Medical Practitioner	None	1801639141	0	0	JOHNSON, MARK NP	10/26/2024	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
292417	Non-Physician Medical Practitioner	None	1326595125	0	0	JOSEPH, WALLY NP	11/20/2020	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
292459	Non-Physician Medical Practitioner	None	1205902905	0	0	JACOBS, TERRY J	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	SUITE 290	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
292499	Non-Physician Medical Practitioner	None	1659961936	0	0	JENNINGS, BEVERLY M PA-C	2/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
292505	Non-Physician Medical Practitioner	None	1033624705	0	0	JIMENEZ, ANASOCHIL	1/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	578 HARGRAVE ST	None	INGLEWOOD	CA	90302	1624	00	06000	33.97882686	-118.3493634	Los Angeles County
292622	Non-Physician Medical Practitioner	None	1710284989	0	0	JARAMILLO, DANIEL F II	5/31/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	660 BUCKTHORN DR	UNIT B	REDDING	CA	96003	5113	00	06000	40.59858094	-122.3581012	Shasta County
292704	Non-Physician Medical Practitioner	None	1942632815	0	0	JAMESON, CAROLYN F NP	12/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	818 E HOME AVE	None	FRESNO	CA	93728	1813	00	06000	36.76326093	-119.8006571	Fresno County
292717	Non-Physician Medical Practitioner	None	1801128012	0	0	JONES, JAMES PA-C	4/14/2025	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	100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
292735	Non-Physician Medical Practitioner	None	1255403770	0	0	JAVANIZADH, KARMEN	9/9/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	1865	00	06000	34.07671715	-118.3799413	Los Angeles County
292755	Non-Physician Medical Practitioner	None	1538782602	0	0	JAMES, TABITHA 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
292760	Non-Physician Medical Practitioner	None	1154821213	0	0	JONES-SMITH, ALEXANDRA NP	6/6/2018	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 ST	None	MERCED	CA	95340	6242	00	06000	37.29309532	-120.4748791	Merced County
292853	Non-Physician Medical Practitioner	None	1306543970	0	0	JAFARISHOURIJEH, MOHAMMADREZA NP	5/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
292885	Non-Physician Medical Practitioner	None	1629406483	0	0	JEANINE, MORENO	1/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 16TH ST	#204	SANTA MONICA	CA	90404	1235	00	06000	34.02726451	-118.4857138	Los Angeles County
292911	Non-Physician Medical Practitioner	None	1740728484	0	0	JEAN, JULIE 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	1501 E 37TH ST	None	LONG BEACH	CA	90807	4215	00	06000	33.82422502	-118.1728327	Los Angeles County
292929	Non-Physician Medical Practitioner	None	1326498361	0	0	JACKSON, KEVIN A	6/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2172 CALAVERA PL	None	FULLERTON	CA	92833	1827	00	06000	33.89306796	-117.9606543	Orange County
293074	Non-Physician Medical Practitioner	None	1629580519	0	0	JOHNSON, BRIDGETT NP	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 ADOBE ST	None	CONCORD	CA	94520	2313	00	06000	37.97700068	-122.0381159	Contra Costa County
293116	Non-Physician Medical Practitioner	None	1477782720	0	0	JUANICO, JUNE ELAINE T PA-C	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	276 W COLLEGE ST	None	COVINA	CA	91723	1902	00	06000	34.08747441	-117.8941951	Los Angeles County
293262	Non-Physician Medical Practitioner	None	1356617021	0	0	JOHNSON, JACQUELINE PA-C	6/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293316	Non-Physician Medical Practitioner	None	1417329640	0	0	JOHN, AGATHA NP	6/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	00	06000	37.66353653	-120.9564675	Stanislaus County
293330	Non-Physician Medical Practitioner	None	1104597095	0	0	JIANG, SHIRLEY X NP	8/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	00	06000	34.13489987	-118.0424069	Los Angeles County
293336	Non-Physician Medical Practitioner	None	1609170513	0	0	JENKINS, LUKE F	6/21/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	00	06000	33.62421676	-117.9309656	Orange County
293345	Non-Physician Medical Practitioner	None	1437361615	0	0	JOCSON, EDWARD SALIBA	9/14/2010	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 DEPT 8681	None	SAN DIEGO	CA	92103	8681	00	06000	32.7537975	-117.1658298	San Diego County
293441	Non-Physician Medical Practitioner	None	1275832008	0	0	JABALI, ALIA	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3835 S JONES BLVD STE 10	None	LAS VEGAS	NV	89103	2283	00	06000	36.11931993	-115.2249434	Clark County
293464	Non-Physician Medical Practitioner	None	1821186487	0	0	JANIAN, VARAND K	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22136 VISCANIO RD	None	WOODLAND HILLS	CA	91364	4112	00	06000	34.15605449	-118.609119	Los Angeles County
293498	Non-Physician Medical Practitioner	None	1760932750	0	0	JONATAN, DIVA M NP	4/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3025 W CHRISTOFFERSEN	APT K208	TURLOCK	CA	95382	8078	00	06000	37.5292063	-120.8826253	Stanislaus County
293537	Non-Physician Medical Practitioner	None	1184018566	0	0	JIMENEZ, FRANK L PA-C	4/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3612 1/2 E FIRST ST	None	LOS ANGELES	CA	90063	2326	00	06000	34.03597431	-118.1886409	Los Angeles County
293540	Non-Physician Medical Practitioner	None	1780208603	0	0	JEIROODI, MARYAM PA-C	10/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 COYLE AVE	UNIT 1	CARMICHAEL	CA	95608	6344	00	06000	38.667807	-121.310748	Sacramento County
293546	Non-Physician Medical Practitioner	None	1811347461	0	0	J, MACLAREN J	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8636 FROBISHER ST	None	SAN DIEGO	CA	92126	3202	00	06000	32.90991852	-117.1382049	San Diego County
293628	Non-Physician Medical Practitioner	None	1528197365	0	0	JACOBS, MONICA L NP	9/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18563 CHICKORY DR	None	RIVERSIDE	CA	92504	9526	00	06000	33.85089099	-117.3594969	Riverside County
293756	Non-Physician Medical Practitioner	None	1093290520	0	0	JOHNSON, KARLEE B PA	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 WEBSTER ST	SUITE 319	SAN FRANCISCO	CA	94115	2373	00	06000	37.7904826	-122.4324477	San Francisco County
293836	Non-Physician Medical Practitioner	None	1164096434	0	0	JOHNSON, TALOR NP	6/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
293878	Non-Physician Medical Practitioner	None	1245929470	0	0	JAEGER, CHRISTINA CNP	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	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	00	06000	33.76299197	-116.444597	Riverside County
293903	Non-Physician Medical Practitioner	None	1851015622	0	0	JOHNSON, SAVANNA L NP	9/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	00	06000	36.359649	-119.331567	Tulare County
293929	Non-Physician Medical Practitioner	None	1750859302	0	0	JANOIAN, JASON M	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	7631 CORY CIR	None	LA PALMA	CA	90623	1559	00	06000	33.85147148	-118.0436983	Orange County
294008	Non-Physician Medical Practitioner	None	1730218231	0	0	JUAREZ, CYNTHIA A CNP	1/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	601 LAS TUNAS DR	STE 101	ARCADIA	CA	91007	8485	00	06000	34.10763646	-118.0510065	Los Angeles County
294080	Non-Physician Medical Practitioner	None	1912300690	0	0	JEAN-PIERRE, STACEY	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	14359 ADDISON ST	APT 301	SHERMAN OAKS	CA	91423	1812	00	06000	34.1612435	-118.4464215	Los Angeles County
294081	Non-Physician Medical Practitioner	None	1558092221	0	0	JINDAL, VARINDER NP	11/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2244	00	06000	35.36875951	-119.0959206	Kern County
294109	Non-Physician Medical Practitioner	None	1811535222	0	0	JINESTA, JONATHAN PA-C	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
294118	Non-Physician Medical Practitioner	None	1013591890	0	0	JEWESS, COLLEEN Z 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	9041 MAGNOLIA AVE	STE 206	RIVERSIDE	CA	92503	3956	00	06000	33.92541585	-117.4378266	Riverside County
294132	Non-Physician Medical Practitioner	None	1245457670	0	0	JOHNSON, AMANDA L NP	7/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
294146	Non-Physician Medical Practitioner	None	1609698091	0	0	JAGGI, MANDEEP	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8860 CENTER DRIVE	SUITE 320	LA MESA	CA	91942	7001	00	06000	32.78189749	-117.0075062	San Diego County
294152	Non-Physician Medical Practitioner	None	1629645718	0	0	JAGODA, JINELLE H PA-C	12/19/2022	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
294187	Non-Physician Medical Practitioner	None	1326422411	0	0	JOHANSSON, ANDREA M NP	9/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1527 ARGUELLO ST	None	REDWOOD CITY	CA	94063	1003	00	06000	37.49304092	-122.2402676	San Mateo County
294226	Non-Physician Medical Practitioner	None	1780675900	0	0	JONES, DONALD RAY	4/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
294248	Non-Physician Medical Practitioner	None	1467819128	0	0	JOHNSON, JOSELYN NP	11/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 COTTAGE AVE	STE 201	MANTECA	CA	95336	4935	00	06000	37.79956104	-121.1982472	San Joaquin County
294265	Non-Physician Medical Practitioner	None	1689619504	0	0	JOHNSON, KALIKA L	5/26/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1055 PINE BLUFF DRIVE	None	PASADENA	CA	91107	1751	00	06000	34.16427108	-118.0775914	Los Angeles County
294300	Non-Physician Medical Practitioner	None	1124019203	0	0	JENKINS, RUTH A NP	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	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	00	06000	37.39572142	-122.1051204	Santa Clara County
294305	Non-Physician Medical Practitioner	None	1629551254	0	0	JOSEPH, RACHEL M 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
294320	Non-Physician Medical Practitioner	None	1649626177	0	0	JOHNSTON, HILARY PA	7/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	00	06000	37.62782298	-122.4223337	San Mateo County
294457	Non-Physician Medical Practitioner	None	1184264517	0	0	JOSIAH, MICHAEL F NP	9/25/2020	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
294525	Non-Physician Medical Practitioner	None	1023210689	0	0	JOHNSON, ANN M	6/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39 ELM STREET	None	SUTTER CREEK	CA	95685	4270	00	06000	38.39122479	-120.8036559	Amador County
294543	Non-Physician Medical Practitioner	None	1083760953	0	0	JUDEN, CHRISTOPHER D	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	11004 ADOBE CREEK COURT	None	BAKERSFIELD	CA	93312	2969	00	06000	35.36574583	-119.1250825	Kern County
294545	Non-Physician Medical Practitioner	None	1124242136	0	0	JAFFE, JASMINE YUZANA	2/7/2008	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	SUITE #5	RIVERSIDE	CA	92503	4001	00	06000	33.92678822	-117.4368632	Riverside County
294594	Non-Physician Medical Practitioner	None	1801109400	0	0	JONES, DANNY RAY	3/14/2011	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 W	STE 110	LANCASTER	CA	93534	3033	00	06000	34.695693	-118.1480965	Los Angeles County
294597	Non-Physician Medical Practitioner	None	1124072087	0	0	JACKSON, BRUCE L	1/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15863 KASOTA RD	None	APPLE VALLEY	CA	92307	4507	00	06000	34.53957208	-117.2667471	San Bernardino County
294664	Non-Physician Medical Practitioner	None	1639799265	0	0	JIMENEZ, MELISSA A PA-C	5/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5101 FLORENCE AVE	STE 4	BELL	CA	90201	3801	00	06000	33.96904913	-118.1757922	Los Angeles County
294713	Non-Physician Medical Practitioner	None	1255303970	0	0	JONES, TERESA P PA	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	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
294736	Non-Physician Medical Practitioner	None	1821324765	0	0	JOHNSON, SAMANTHA J NP	12/3/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11534 ANDERSON ST	None	LOMA LINDA	CA	92354	3411	00	06000	34.04415326	-117.2614379	San Bernardino County
294738	Non-Physician Medical Practitioner	None	1851548564	0	0	JENNISON, STEPHANIE J	3/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19191 S VERMONT AVE	None	TORRANCE	CA	90502	1018	00	06000	33.85645867	-118.2905747	Los Angeles County
294755	Non-Physician Medical Practitioner	None	1710650940	0	0	JORDAN, MYKALA PA	4/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
294783	Non-Physician Medical Practitioner	None	1912076399	0	0	JACKSON, ELIZABETH A NP	4/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11520 PINEHAVEN AVE	None	BAKERSFIELD	CA	93312	3650	00	06000	35.3751305	-119.1309525	Kern County
294817	Non-Physician Medical Practitioner	None	1023635513	0	0	JURADO, CHRYSTAL JOY D	8/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19682 HESPERIAN BLVD	STE 101	HAYWARD	CA	94541	4752	00	06000	37.66812177	-122.1194688	Alameda County
294820	Non-Physician Medical Practitioner	None	1336595677	0	0	JACOBER, JULIANNE F CNM	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	2210 E ILLINOIS AVE	SUITE 408	FRESNO	CA	93701	2168	00	06000	36.74500687	-119.7846885	Fresno County
294857	Non-Physician Medical Practitioner	None	1568788081	0	0	JIMENA, VINCENT G M NP	5/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10801 LELAND AVE	None	WHITTIER	CA	90605	3618	00	06000	33.93476058	-118.0420384	Los Angeles County
294873	Non-Physician Medical Practitioner	None	1902650484	0	0	JIMENEZ, TATIANA Y NP	12/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
294877	Non-Physician Medical Practitioner	None	1316438807	0	0	JOHNSON, BRYAN R PA-C	12/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
295081	Non-Physician Medical Practitioner	None	1205299559	0	0	JOOBBANI, BITA PA-C	12/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
295154	Non-Physician Medical Practitioner	None	1851434617	0	0	JOSTOCK, ERIC J	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	950 MAIN ST	STE 203	EL SEGUNDO	CA	90245	5218	00	06000	33.930135	-118.415944	Los Angeles County
295157	Non-Physician Medical Practitioner	None	1649908518	0	0	JANI-HOANG, VANNA NP	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1042 E CHAPMAN	None	ORANGE	CA	92866	2111	00	06000	33.78782652	-117.84249	Orange County
295244	Non-Physician Medical Practitioner	None	1306555941	0	0	JUNG, CAROL PA-C	8/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7643 S ATLANTIC AVE	None	CUDAHY	CA	90201	5019	00	06000	33.96585232	-118.18712	Los Angeles County
295267	Non-Physician Medical Practitioner	None	1063584126	0	0	JOHNSON, STEVEN D	5/17/2011	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
295348	Non-Physician Medical Practitioner	None	1922502053	0	0	JOSHUA, SOLOMON	1/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10631 MENTESANA AVE	None	LAS VEGAS	NV	89166	8021	00	06000	36.27931383	-115.3304442	Clark County
295494	Non-Physician Medical Practitioner	None	1942713201	0	0	JOSEPH, DAPHNIE C NP	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	06000	36.19740597	-115.1207123	Clark County
295520	Non-Physician Medical Practitioner	None	1386951465	0	0	JOHNSON, MARY A	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	2788 TRAPPER SPRINGS AVE	None	TULARE	CA	93274	6261	00	06000	36.19848979	-119.3066481	Tulare County
295527	Non-Physician Medical Practitioner	None	1255600581	0	0	JOHNSON, THERESA C N NP	7/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	327 MOUNTAIN VIEW AVE	None	SAN RAFAEL	CA	94901	1371	00	06000	37.98903488	-122.5112627	Marin County
295565	Non-Physician Medical Practitioner	None	1972639839	0	0	JACOBS, DOUGLAS G	3/4/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3 BOLTON PLACE	None	MENLO PARK	CA	94025	5601	00	06000	37.44343617	-122.1901073	San Mateo County
295604	Non-Physician Medical Practitioner	None	1477106383	0	0	JOHNSON, ANITA L NP	12/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	00	06000	37.33874349	-120.467493	Merced County
295607	Non-Physician Medical Practitioner	None	1699783852	0	0	JONES, ROBERT SUTHERLAND	4/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
295624	Non-Physician Medical Practitioner	None	1760824353	0	0	JOHNSON, NATALIE M NP	8/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12662 SAINT MARK ST	None	GARDEN GROVE	CA	92845	2432	00	06000	33.77875995	-118.0354207	Orange County
295629	Non-Physician Medical Practitioner	None	1184389934	0	0	JENSEN, ADRIENNE O NP	5/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
295636	Non-Physician Medical Practitioner	None	1437469269	0	0	JOHNSON, TIFFANY D NP	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 S FIGUEROA ST	APT 503	LOS ANGELES	CA	90015	3918	00	06000	34.04597069	-118.2630294	Los Angeles County
295642	Non-Physician Medical Practitioner	None	1285644294	0	0	JACQUEZ, JESSE J	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	23080 ALESSANDRO BLVD ST	None	MORENO VALLEY	CA	92553	9674	00	06000	33.91731429	-117.2599095	Riverside County
295684	Non-Physician Medical Practitioner	None	1942818356	0	0	JAMERSON, KRISTIAN 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	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	00	06000	33.87790309	-117.589666	Riverside County
295689	Non-Physician Medical Practitioner	None	1326265802	0	0	JOHNSTON, RENEE F	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	6213 PASEO PRIVADO	None	CARLSBAD	CA	92009	1010	00	06000	33.12498814	-117.2316016	San Diego County
295697	Non-Physician Medical Practitioner	None	1497838437	0	0	JENNINGS, JULIE ZURLINDEN	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	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	00	06000	38.644479	-121.1349735	Sacramento County
295774	Non-Physician Medical Practitioner	None	1861276529	0	0	JUNCAJ, DAMIAN N PA-C	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	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	00	06000	34.05101259	-118.217259	Los Angeles County
295812	Non-Physician Medical Practitioner	None	1427275833	0	0	JONUSAS, ALEXANDER M PA-C	8/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 N ROSE AVE	STE 220	OXNARD	CA	93030	7640	00	06000	34.21746	-119.155545	Ventura County
295816	Non-Physician Medical Practitioner	None	1750388716	0	0	JOHNSON, LISA M	4/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	285 SANTA ANA AVE	None	LONG BEACH	CA	90803	3570	00	06000	33.7618124	-118.1281798	Los Angeles County
295853	Non-Physician Medical Practitioner	None	1780302711	0	0	JOHNSON, KARRYLEE CNP	10/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
295945	Non-Physician Medical Practitioner	None	1962156570	0	0	JOSEPH, DAPHINE PA-C	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	403 S LONG BEACH BLVD	STE B	COMPTON	CA	90221	3491	00	06000	33.89318091	-118.2078742	Los Angeles County
295977	Non-Physician Medical Practitioner	None	1144037169	0	0	JAWAID, SHAIDA	2/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
295986	Non-Physician Medical Practitioner	None	1679359665	0	0	JAVELLANA, JORDAN PA-C	12/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	00	06000	33.80318353	-118.0666665	Orange County
296063	Non-Physician Medical Practitioner	None	1962652974	0	0	JAMESON, AMANDA M	10/27/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	880 E SANTA CLARA STREET	None	VENTURA	CA	93001	2939	00	06000	34.27952579	-119.287375	Ventura County
296110	Non-Physician Medical Practitioner	None	1134331259	0	0	JACKSON, COLLEEN DELORES	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	8700 BEVERLY BLVD	THALIANS 2W, RM 218	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296130	Non-Physician Medical Practitioner	None	1225557903	0	0	JIANG, FANG PA	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 16TH STREET	STE 2100	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
296150	Non-Physician Medical Practitioner	None	1447451786	0	0	JONES, SHAWNA M PA-C	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	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
296171	Non-Physician Medical Practitioner	None	1902808686	0	0	JOHNSON, KARIN JANE	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	00	06000	38.72845186	-121.2904134	Placer County
296325	Non-Physician Medical Practitioner	None	1841630464	0	0	JAMISON, JULIE K NP	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1741 EASTLAKE PARKWAY	SUITE 107	CHULA VISTA	CA	91915	2032	00	06000	32.62008814	-116.9622762	San Diego County
296327	Non-Physician Medical Practitioner	None	1427292762	0	0	JAMES, SANDOVAL M PA	8/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	264 N HIGHLAND SPRINGS A	SUITE 5A	BANNING	CA	92220	3082	00	06000	33.93063	-116.946864	Riverside County
296329	Non-Physician Medical Practitioner	None	1811512072	0	0	JENG, ANNABEL NP	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5451 WALNUT AVE	None	CHINO	CA	91710	2609	00	06000	34.02626886	-117.6858645	San Bernardino County
296331	Non-Physician Medical Practitioner	None	1689862450	0	0	JOHNSON, AUTUMN M	2/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8465 REGENTS ROAD	APT 205	SAN DIEGO	CA	92122	1385	00	06000	32.8668361	-117.2194732	San Diego County
296343	Non-Physician Medical Practitioner	None	1871871137	0	0	JOHNSTONE, LORA D 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	630 WENDOVER ROAD	None	FLINTRIDGE	CA	91011	4129	00	06000	34.17879393	-118.1870872	Los Angeles County
296429	Non-Physician Medical Practitioner	None	1811418734	0	0	JUPENA, JORDAN L PA	3/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
296449	Non-Physician Medical Practitioner	None	1396702544	0	0	JARRETT, JANENE E NP	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1407 E TICONDEROGA DR	None	FRESNO	CA	93720	1335	00	06000	36.87851051	-119.7580185	Fresno County
296519	Non-Physician Medical Practitioner	None	1568060853	0	0	JACKSON, SHARONDA PA-C	1/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DR	STE 600	LA MESA	CA	91942	3061	00	06000	32.78189749	-117.0075062	San Diego County
296520	Non-Physician Medical Practitioner	None	1629562467	0	0	JOHNSEN, ERIN L 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	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
296573	Non-Physician Medical Practitioner	None	1598233256	0	0	JOHNSON, ZACHARY A PA-C	8/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	713 N DOUGLAS ST.	None	EL SEGUNDO	CA	90245	2830	00	06000	33.92546537	-118.3832318	Los Angeles County
296625	Non-Physician Medical Practitioner	None	1841658648	0	0	JOHNSTON, JUDY	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	20000 PUENTE COURT	None	SARATOGA	CA	95070	3937	00	06000	37.28639443	-122.0210899	Santa Clara County
296646	Non-Physician Medical Practitioner	None	1750692554	0	0	JONES, ANITA 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	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	00	06000	33.93374098	-118.1445557	Los Angeles County
296703	Non-Physician Medical Practitioner	None	1134460603	0	0	JAMES, MELODY NP	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	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	00	06000	37.89859467	-122.0843018	Contra Costa County
296759	Non-Physician Medical Practitioner	None	1700144771	0	0	JALLOH, FATMATA NP	2/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	209 W FIAT ST	None	CARSON	CA	90745	2907	00	06000	33.8273945	-118.2803445	Los Angeles County
296763	Non-Physician Medical Practitioner	None	1588461867	0	0	JUFIAR, LAUREN M PA-C	3/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
296778	Non-Physician Medical Practitioner	None	1962663005	0	0	JANE, MAUN-VIDUYA M PA-C	6/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
296803	Non-Physician Medical Practitioner	None	1932350485	0	0	JASENIUK, JONATHAN R	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	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
296951	Non-Physician Medical Practitioner	None	1477011427	0	0	JIHANI, MANDI	9/25/2019	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 104	PANORAMA CITY	CA	91402	4810	00	06000	34.22026244	-118.4488066	Los Angeles County
297016	Non-Physician Medical Practitioner	None	1750753141	0	0	JANSON, AMBER L	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	434 1/2 BOND ST	None	REDLANDS	CA	92373	5862	00	06000	34.04398541	-117.1868996	San Bernardino County
297047	Non-Physician Medical Practitioner	None	1174080030	0	0	JACKSON, BRIAN J NP	10/15/2019	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
297250	Non-Physician Medical Practitioner	None	1750854865	0	0	JIMENEZ, SUSANA G	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
297251	Non-Physician Medical Practitioner	None	1548719222	0	0	JOHNSON, ZOE E	9/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18501 ST MORITZ DR	None	TARZANA	CA	91356	5713	00	06000	34.14587948	-118.535155	Los Angeles County
297270	Non-Physician Medical Practitioner	None	1811343791	0	0	JNO BAPTISTE, NATASHA NP	11/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7720 N FRESNO ST	STE 104	FRESNO	CA	93720	2407	00	06000	36.85068226	-119.7836282	Fresno County
297339	Non-Physician Medical Practitioner	None	1366501082	0	0	JOHNSON, ALICIA M	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	8200 HAVEN AVE	APT 5101	RANCHO CUCAMONGA	CA	91730	6967	00	06000	34.10442	-117.5786685	San Bernardino County
297414	Non-Physician Medical Practitioner	None	1003181926	0	0	JOHNSON, MELLYN A NP	4/5/2021	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
297431	Non-Physician Medical Practitioner	None	1134837891	0	0	JARVIS, JAMIE C PA	1/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
297509	Non-Physician Medical Practitioner	None	1639390578	0	0	JACKSON, JANETTE L	6/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11506 MARCELLO WAY	None	RANCHO CUCAMONGA	CA	91701	9202	00	06000	34.13167332	-117.553929	San Bernardino County
297530	Non-Physician Medical Practitioner	None	1689422891	0	0	JIMENEZ, JENNICA NP	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	15381 7TH ST	STE 2-3	VICTORVILLE	CA	92395	3858	00	06000	34.53171716	-117.2981568	San Bernardino County
297536	Non-Physician Medical Practitioner	None	1285794388	0	0	JOHNSON, CHARLIE J JR	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	22400 PHILIPRIMM ST	None	WOODLAND HILLS	CA	91367	4461	00	06000	34.17280347	-118.6149195	Los Angeles County
297576	Non-Physician Medical Practitioner	None	1255490975	0	0	JONES, KARMEN M CNM	8/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1775 VISTOSO DR	None	RIVERSIDE	CA	92507	8816	00	06000	33.96694245	-117.3500241	Riverside County
297644	Non-Physician Medical Practitioner	None	1558034637	0	0	JUAT, MICHELLE NP	3/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
297684	Non-Physician Medical Practitioner	None	1720193220	0	0	JOSEPH-GREEN, BRIDGETTE MICHELLE	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	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	00	06000	38.00403417	-121.8422798	Contra Costa County
297719	Non-Physician Medical Practitioner	None	1831520584	0	0	JONES, JOANNA V	10/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19921 WONG COURT	None	CANYON COUNTRY	CA	91351	3819	00	06000	34.43817889	-118.4838061	Los Angeles County
297727	Non-Physician Medical Practitioner	None	1184900870	0	0	JAGAJEEVAN, VEENA N NP	11/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4406 ARROWWOOD CT	None	CONCORD	CA	94521	4427	00	06000	37.95065115	-121.9949713	Contra Costa County
297751	Non-Physician Medical Practitioner	None	1043634686	0	0	JOHN, MONCY R 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	10314 STERLING SILVER ST	None	BAKERSFIELD	CA	93311	9524	00	06000	35.30482548	-119.1173535	Kern County
297778	Non-Physician Medical Practitioner	None	1164089371	0	0	JURI, NICOLA J PA	9/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
297786	Non-Physician Medical Practitioner	None	1659118131	0	0	JOHNSTON, KIERSTEN L PA	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	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
297806	Non-Physician Medical Practitioner	None	1174760961	0	0	JACKSON, ANISHA N PA	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	416 W FOOTHILL BLVD	None	RIALTO	CA	92376	4953	00	06000	34.10677653	-117.3773835	San Bernardino County
297815	Non-Physician Medical Practitioner	None	1083259386	0	0	JUNIO, VIRGIL C PA	4/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4929 VAN NUYS BLVD	ATTN: EMERGENCY DEPT	SHERMAN OAKS	CA	91403	1702	00	06000	34.1602022	-118.4487313	Los Angeles County
297900	Non-Physician Medical Practitioner	None	1164461745	0	0	JEFFREY, KEITH A	6/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3068 FALTINGS CT	None	LIVERMORE	CA	94550	6582	00	06000	37.66331899	-121.7541296	Alameda County
298051	Non-Physician Medical Practitioner	None	1548720816	0	0	JOHNSON, KYLE P PA	1/3/2022	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
298063	Non-Physician Medical Practitioner	None	1851877930	0	0	JACOBSON, BRIAN J PA-C	12/6/2022	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
298092	Non-Physician Medical Practitioner	None	1952558850	0	0	JONES, KARA E 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	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
298095	Non-Physician Medical Practitioner	None	1093023509	0	0	JACKSON, MICHELLE L NP	3/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2911 PINE GROVE COURT	None	SPRING VALLEY	CA	91978	1502	00	06000	32.73349694	-116.9654072	San Diego County
298137	Non-Physician Medical Practitioner	None	1891221263	0	0	JANUS, OLIVIA I PA-C	7/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
298154	Non-Physician Medical Practitioner	None	1689223646	0	0	JACKSON, SARA NP	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
298156	Non-Physician Medical Practitioner	None	1912298217	0	0	JOANN, CHAN	2/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	407 W COLLEGE ST	None	LOS ANGELES	CA	90012	2313	00	06000	34.06413934	-118.237719	Los Angeles County
298182	Non-Physician Medical Practitioner	None	1053753558	0	0	JOSHI, CHELSEA J	2/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	559 BARCELONA DR	None	FREMONT	CA	94536	2603	00	06000	37.57558385	-121.9922886	Alameda County
298253	Non-Physician Medical Practitioner	None	1659688364	0	0	JOY, CHRISTINE RENEE	12/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	06000	35.220006	-114.0380145	Mohave County
298310	Non-Physician Medical Practitioner	None	1104274596	0	0	JWCH INSTITUTE, INC	9/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15898 E GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1432	00	06000	34.01001897	-117.9604613	Los Angeles County
298336	Non-Physician Medical Practitioner	None	1497249775	0	0	JOSEPH, DAPHNEY PA-C	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	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	00	06000	34.18784988	-118.6427021	Los Angeles County
298350	Non-Physician Medical Practitioner	None	1114940988	0	0	JENNICHES, STEPHANIE D	5/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
298352	Non-Physician Medical Practitioner	None	1962267542	0	0	JOHAL, KARANDEEP S NP	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
298358	Non-Physician Medical Practitioner	None	1124156617	0	0	JUAREZ, LOURDES	2/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
298363	Non-Physician Medical Practitioner	None	1255028205	0	0	JAIME, KRISTAL	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298416	Non-Physician Medical Practitioner	None	1689012718	0	0	JABARI, MARYAM N	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	338 SPEAR ST	UNIT 10H	SAN FRANCISCO	CA	94105	6172	00	06000	37.78960566	-122.3904171	San Francisco County
298429	Non-Physician Medical Practitioner	None	1043859978	0	0	JAMA, FARAH	3/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298448	Non-Physician Medical Practitioner	None	1063972339	0	0	JANG, BRITTANY K PA	5/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	00	06000	37.7634502	-122.4579779	San Francisco County
298471	Non-Physician Medical Practitioner	None	1477029791	0	0	JOURABCHIAN, TANNAZ T PA	4/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
298607	Non-Physician Medical Practitioner	None	1215535034	0	0	JOHN, SHIJI NP	7/24/2024	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
298701	Non-Physician Medical Practitioner	None	1578907069	0	0	JOLLIFFE, ALYSSA M NP	2/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	154 SUNCREST DRIVE	None	SOQUEL	CA	95073	2000	00	06000	37.02780505	-121.9749652	Santa Cruz County
298772	Non-Physician Medical Practitioner	None	1548310303	0	0	JULIAN, JILL MARIE	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	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
298791	Non-Physician Medical Practitioner	None	1164043808	0	0	JOHNSON, AMY J PA-C	12/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
298825	Non-Physician Medical Practitioner	None	1184312860	0	0	JAHROMI, SAHAR K PA	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
298864	Non-Physician Medical Practitioner	None	1720370117	0	0	JUSTINO, CHRISTOPHER SCOTT	11/3/2011	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 STREET	SUITE 4300	LOS ANGELES	CA	90033	5324	00	06000	34.06269295	-118.2030006	Los Angeles County
298924	Non-Physician Medical Practitioner	None	1831259241	0	0	JHU, JEANNIE	8/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
298951	Non-Physician Medical Practitioner	None	1699527010	0	0	JACKSON, DELISA NP	7/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 LONE TREE WAY	None	BRENTWOOD	CA	94513	5256	00	06000	37.9617515	-121.730436	Contra Costa County
299030	Non-Physician Medical Practitioner	None	1770314205	0	0	JEFFERSON, WENDY NP	10/3/2024	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
299058	Non-Physician Medical Practitioner	None	1669981627	0	0	JONES, STEPHANIE M NP	11/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 E 7TH ST	None	LONG BEACH	CA	90813	5002	00	06000	33.77531254	-118.1728263	Los Angeles County
299089	Non-Physician Medical Practitioner	None	1649601253	0	0	JOHNSON, STEPHEN K NP	2/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	00	06000	36.57482436	-121.8101797	Monterey County
299093	Non-Physician Medical Practitioner	None	1194962605	0	0	JACOB, MELCHOR Z	6/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5208 SUN VALLEY CIRCLE	None	BAKERSFIELD	CA	93313	6054	00	06000	35.29806749	-119.060685	Kern County
299118	Non-Physician Medical Practitioner	None	1790408045	0	0	JOHNSON, CHRISTINE M 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	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
299137	Non-Physician Medical Practitioner	None	1992771232	0	0	JENSEN, LILIAN	8/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S BUENA VISTA ST	SUITE 150	BURBANK	CA	91505	4504	00	06000	34.15872557	-118.3283863	Los Angeles County
299153	Non-Physician Medical Practitioner	None	1215932272	0	0	JAMES, MARY PA-C	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	1328 NATIVIDAD ROAD	None	SALINAS	CA	93906	3101	00	06000	36.69930093	-121.6350349	Monterey County
299238	Non-Physician Medical Practitioner	None	1124419684	0	0	JORDAN, MICHELE	9/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	06000	36.214524	-116.025615	Nye County
299267	Non-Physician Medical Practitioner	None	1629544556	0	0	JOHNSTON, KATY PA	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	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
299323	Non-Physician Medical Practitioner	None	1831508423	0	0	JUBAN, MELODY NP	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	715 CORNERSTONE LANE	None	SAN JOSE	CA	95123	6839	00	06000	37.24293212	-121.7967318	Santa Clara County
299362	Non-Physician Medical Practitioner	None	1477182053	0	0	JOHNSON, HANNAH PA-C	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	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
299421	Non-Physician Medical Practitioner	None	1043074438	0	0	JUDILLA, JUSTIN PA	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	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	00	06000	32.63367609	-117.0769202	San Diego County
299450	Non-Physician Medical Practitioner	None	1427452648	0	0	JONES, DUSTIN C PA	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
299452	Non-Physician Medical Practitioner	None	1215472949	0	0	JACOB, BERNICE J	8/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	914 HIBISCUS WAY	None	PLACENTIA	CA	92870	4716	00	06000	33.8785494	-117.8585383	Orange County
299457	Non-Physician Medical Practitioner	None	1801597539	0	0	JULOM, MYRA BELLE PA	3/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
299460	Non-Physician Medical Practitioner	None	1881019040	0	0	JONES, JULIE A NP	6/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	380 22ND AVE	STE 3	SAN FRANCISCO	CA	94121	2110	00	06000	37.78071952	-122.4815438	San Francisco County
299521	Non-Physician Medical Practitioner	None	1003061532	0	0	JACOBS, JESSE	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E CARRILLO ST	None	SANTA BARBARA	CA	93101	1460	00	06000	34.42588572	-119.6972176	Santa Barbara County
299536	Non-Physician Medical Practitioner	None	1730778978	0	0	JOHNSON, ANDREW W PA-C	9/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
299592	Non-Physician Medical Practitioner	None	1679006324	0	0	JANDAY, NAVJOT K NP	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2577 SAMARITAN DR	STE 705	SAN JOSE	CA	95124	4105	00	06000	37.25246494	-121.9501879	Santa Clara County
299636	Non-Physician Medical Practitioner	None	1619012689	0	0	JUSTINIANI, MARY GRACE CABATAS	1/30/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14044 VICTORY BLVD	None	VAN NUYS	CA	91401	2226	00	06000	34.18664147	-118.439334	Los Angeles County
299640	Non-Physician Medical Practitioner	None	1205183688	0	0	JURASINSKI, PHILIP N NP	12/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4360 S WOODPINE DR	UNIT 102	LAS VEGAS	NV	89119	7836	00	06000	36.10987977	-115.1219216	Clark County
299671	Non-Physician Medical Practitioner	None	1972964278	0	0	JAMES, DANA R PA-C	10/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
299682	Non-Physician Medical Practitioner	None	1750010203	0	0	JENSEN, SARINA M NP	6/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15720 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3337	00	06000	37.24027269	-121.9767692	Santa Clara County
299803	Non-Physician Medical Practitioner	None	1336554104	0	0	JOHNSTON, JULIA V	10/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1633 AMBERWOOD DRIVE	APT 39	SOUTH PASADENA	CA	91030	5103	00	06000	34.12268652	-118.148877	Los Angeles County
299943	Non-Physician Medical Practitioner	None	1912274622	0	0	JON-UBABUCO, NNEKA C 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
299973	Non-Physician Medical Practitioner	None	1033799457	0	0	JACKS, YANA PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
300032	Non-Physician Medical Practitioner	None	1346581535	0	0	JANG, JESSICA S NP	8/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1730 CANYONLANDS WAY	None	RENO	NV	89521	4083	00	06000	39.44619885	-119.739808	Washoe County
300077	Non-Physician Medical Practitioner	None	1811415276	0	0	JOHNSON, MEREDITH M	7/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 SARATOGA AVE	APT 229	SANTA CLARA	CA	95051	7394	00	06000	37.3236247	-121.96966	Santa Clara County
300087	Non-Physician Medical Practitioner	None	1457302101	0	0	JORGENSEN, MICHAEL B	6/3/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BROADWAY ST	PAVILION A, 2ND FLOOR	REDWOOD CITY	CA	94063	3132	00	06000	37.48523183	-122.2025998	San Mateo County
300110	Non-Physician Medical Practitioner	None	1861931289	0	0	JEAN, MA LOISE A NP	10/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
300118	Non-Physician Medical Practitioner	None	1720097108	0	0	JEHLE, LYNN	3/21/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 COLBY ST	SUITE 201	BERKELEY	CA	94705	2058	00	06000	37.85473248	-122.2575793	Alameda County
300119	Non-Physician Medical Practitioner	None	1023483591	0	0	JACOBS, RYAN PA	11/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
300155	Non-Physician Medical Practitioner	None	1780255216	0	0	JAVIER, ROSY I NP	6/3/2022	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
300201	Non-Physician Medical Practitioner	None	1104985696	0	0	JOHNSON, MICHAEL PAUL	8/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2845 SIENA HEIGHTS DR	None	HENDERSON	NV	89052	4153	00	06000	36.00359577	-115.1131344	Clark County
300245	Non-Physician Medical Practitioner	None	1700372760	0	0	JOHAL, JANINE PA-C	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
300358	Non-Physician Medical Practitioner	None	1578005138	0	0	JEW, KELLI N NP	1/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	357 MARINA BLVD	None	SAN FRANCISCO	CA	94123	1213	00	06000	37.80620777	-122.4386797	San Francisco County
300374	Non-Physician Medical Practitioner	None	1457705758	0	0	JOHL, SHARANDEEP K NP	7/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1127 KENSINGTON WAY	None	YUBA CITY	CA	95991	3474	00	06000	39.16590362	-121.6311376	Sutter County
300403	Non-Physician Medical Practitioner	None	1205482064	0	0	JOHNSTON, AUDREY L 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	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
300490	Non-Physician Medical Practitioner	None	1578846614	0	0	JORDAN, LAMITSOI K	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	1001 63RD STREET	APT 5	OAKLAND	CA	94608	1254	00	06000	37.84662244	-122.280287	Alameda County
300593	Non-Physician Medical Practitioner	None	1669406112	0	0	JAMERO, GINA M	4/7/2005	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
300609	Non-Physician Medical Practitioner	None	1588612667	0	0	J, MALLORY R	4/24/2009	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	#8821	SAN DIEGO	CA	92103	9000	00	06000	32.7537975	-117.1658298	San Diego County
300613	Non-Physician Medical Practitioner	None	1356731335	0	0	JIMENEZ, BRIANA PA	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7172 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3804	00	06000	33.94477707	-117.4034127	Riverside County
300649	Non-Physician Medical Practitioner	None	1548966096	0	0	JOHNS, ELENA NP	8/14/2023	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
300715	Non-Physician Medical Practitioner	None	1073210514	0	0	JONES, STACEY Y NP	3/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1331 W AVENUE J	SUITE 101	LANCASTER	CA	93534	2942	00	06000	34.68946152	-118.155699	Los Angeles County
300742	Non-Physician Medical Practitioner	None	1962437772	0	0	JONES, LOUANNE	1/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	06000	33.457203	-112.0262625	Maricopa County
300798	Non-Physician Medical Practitioner	None	1437214533	0	0	JOHNSTONE, BRIAN DAVID	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
300843	Non-Physician Medical Practitioner	None	1548716855	0	0	JOCIUS, JESSICA A NP	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	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
300946	Non-Physician Medical Practitioner	None	1629705249	0	0	JUAREZ, KIMBERLY D NP	10/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	00	06000	36.98815433	-121.9571695	Santa Cruz County
301046	Non-Physician Medical Practitioner	None	1073753000	0	0	JANG, CECILIA J	5/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5576 ZEINER COURT	None	ATWATER	CA	95301	9594	00	06000	37.32502982	-120.5880646	Merced County
301081	Non-Physician Medical Practitioner	None	1245777663	0	0	JEYASINGH, CHRISTIEN NP	4/4/2018	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
301107	Non-Physician Medical Practitioner	None	1730602376	0	0	JOHNSON, HAYLEY R PA-C	7/17/2020	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
301122	Non-Physician Medical Practitioner	None	1912549700	0	0	JARDELEZA, PAULYNE THERESE NP	7/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
301150	Non-Physician Medical Practitioner	None	1679105407	0	0	JONES, EMILY A PA	7/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
301162	Non-Physician Medical Practitioner	None	1497791263	0	0	JOHNSON, MICHAEL S	5/1/1998	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
301214	Non-Physician Medical Practitioner	None	1407182157	0	0	JOB, JOJY	4/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10051 VALLEY CIRCLE	None	CHATSWORTH	CA	91311	7468	00	06000	34.25301895	-118.616496	Los Angeles County
301292	Non-Physician Medical Practitioner	None	1467962795	0	0	JOHNSON, CHELSEA L	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	730 WILDCAT CANYON RD	None	BERKELEY	CA	94708	1537	00	06000	37.8992124	-122.2589039	Alameda County
301314	Non-Physician Medical Practitioner	None	1245757020	0	0	JAPZON, JOYLEEN A	2/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	845 FULFORD COURT	None	HENDERSON	NV	89052	3818	00	06000	35.99715344	-115.1174072	Clark County
301394	Non-Physician Medical Practitioner	None	1417923079	0	0	JUNG, ANNA MARIE	2/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23451 MADISON ST	SUITE 300	TORRANCE	CA	90505	4763	00	06000	33.81197627	-118.3478154	Los Angeles County
301449	Non-Physician Medical Practitioner	None	1295490209	0	0	JUAREZ, MARCO TEODORO L NP	5/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1125 S BEVERLY DR	720	LOS ANGELES	CA	90035	1180	00	06000	34.05696658	-118.3966613	Los Angeles County
301462	Non-Physician Medical Practitioner	None	1477780591	0	0	JACOBSON, ALICIA	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	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444782	-119.7794675	Santa Barbara County
301497	Non-Physician Medical Practitioner	None	1881703544	0	0	JONES, DONNA LYNNE	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	500 DOYLE PARK DR	SUITE 100	SANTA ROSA	CA	95405	4558	00	06000	38.44332	-122.6985255	Sonoma County
301575	Non-Physician Medical Practitioner	None	1396752689	0	0	JIMENEZ, CONCEPCION	1/1/1978	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	00	06000	34.0565363	-118.2728437	Los Angeles County
301625	Non-Physician Medical Practitioner	None	1205097136	0	0	JAMES, MARIDEL D	12/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7630 PAINTER AVE	None	WHITTIER	CA	90602	2357	00	06000	33.972534	-118.032652	Los Angeles County
301705	Non-Physician Medical Practitioner	None	1992348205	0	0	JUSTO, MARIA ANGELICA C NP	4/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	754 MEDICAL CENTER CT	STE 206	CHULA VISTA	CA	91911	6656	00	06000	32.61778462	-117.0228924	San Diego County
301724	Non-Physician Medical Practitioner	None	1619901188	0	0	JOE, NINA C	4/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1026 ASH ST	None	ARROYO GRANDE	CA	93420	7808	00	06000	35.11473292	-120.5944797	San Luis Obispo County
301817	Non-Physician Medical Practitioner	None	1407263486	0	0	JAEGER, ERIN R	10/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13164 SURLYN WAY	None	BEAUMONT	CA	92223	8138	00	06000	33.94535254	-117.0247087	Riverside County
301873	Non-Physician Medical Practitioner	None	1265967079	0	0	JUSTIN, JASON E	8/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 GEORGE LN	None	SANTA ROSA	CA	95403	4201	00	06000	38.47689	-122.7674205	Sonoma County
301877	Non-Physician Medical Practitioner	None	1386898591	0	0	JONSON, EMMANUEL E	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	00	06000	38.67021	-121.145382	Sacramento County
301891	Non-Physician Medical Practitioner	None	1831105287	0	0	JACK-MOONEY, NOREEN TRESA	2/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	80 B VETERANS BLVD	I-40, EXIT 102	ACOMA	NM	87034	0000	00	06000	35.058483	-107.5870575	Cibola County
302011	Non-Physician Medical Practitioner	None	1700638293	0	0	JACOB, SHINY NP	11/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	00	06000	34.13470788	-117.262434	San Bernardino County
302048	Non-Physician Medical Practitioner	None	1811395437	0	0	JANI, MAHESHWAR C PA	10/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 N FRESNO	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
302106	Non-Physician Medical Practitioner	None	1114356789	0	0	JOSUE, JOANNA S D NP	4/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2276 N BEACHWOOD DRIVE	UNIT 101 A	LOS ANGELES	CA	90068	3181	00	06000	34.11225427	-118.3214602	Los Angeles County
302218	Non-Physician Medical Practitioner	None	1033107891	0	0	JOHNSON, JANE MARGUERITE	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	2755 HERNDON AVE	CLOVIS COMMUNITY MEDICAL	CLOVIS	CA	93611	0000	00	06000	36.83745149	-119.6604315	Fresno County
302293	Non-Physician Medical Practitioner	None	1649804469	0	0	JONES, LAKESHA E NP	10/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
302321	Non-Physician Medical Practitioner	None	1386391555	0	0	JOHNSON, KIMBERLY NP	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	# 551	SAN BERNARDINO	CA	92404	3861	00	06000	34.1358627	-117.2757778	San Bernardino County
302336	Non-Physician Medical Practitioner	None	1750424248	0	0	JUNSAY, RYAN	3/21/2008	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 STE	None	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
302342	Non-Physician Medical Practitioner	None	1083967269	0	0	JACKSON, MARY K NP	12/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4917 ROCK BOTTOM	None	BAKERSFIELD	CA	99312	6637	00	06000	35.40510226	-119.0941872	Kern County
302343	Non-Physician Medical Practitioner	None	1356404305	0	0	JASSO, MICHAEL D PA	2/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12649 BAR HARBOR ST	None	VICTORVILLE	CA	92392	4815	00	06000	34.45142739	-117.3879367	San Bernardino County
302345	Non-Physician Medical Practitioner	None	1700089224	0	0	JEWELL, JENNIFER P 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	705 SUNLIT LANE	None	SANTA CRUZ	CA	95060	9435	00	06000	37.07163254	-122.1340522	Santa Cruz County
302383	Non-Physician Medical Practitioner	None	1669929949	0	0	JUNG, PEGGY D NP	10/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	845 N 10TH ST	STE 2	SANTA PAULA	CA	93060	1347	00	06000	34.36592531	-119.0656897	Ventura County
302394	Non-Physician Medical Practitioner	None	1518243542	0	0	JAY, VIVIAN S 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	3045 GREEN OAK CT	None	SAN MATEO	CA	94403	3833	00	06000	37.52983258	-122.3228982	San Mateo County
302396	Non-Physician Medical Practitioner	None	1518435437	0	0	JACKSON, VICTORIA L NP	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2147 E MINARETS	None	FRESNO	CA	93720	0134	00	06000	36.84379658	-119.745004	Fresno County
302493	Non-Physician Medical Practitioner	None	1598174591	0	0	JIANG, WENTING NP	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 MERCED AVE	None	SAN FRANCISCO	CA	94127	1027	00	06000	37.74495442	-122.4608261	San Francisco County
302532	Non-Physician Medical Practitioner	None	1528249638	0	0	JACKSON, KATHERINE	10/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5810 OBATA WAY	SUITE #1	GILROY	CA	95020	7039	00	06000	36.98577443	-121.5507749	Santa Clara County
302612	Non-Physician Medical Practitioner	None	1578658746	0	0	JOHNSON, MARK	7/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1725 GENTLE BREEZE LN	None	ENCINITAS	CA	92024	1968	00	06000	33.05390757	-117.2511808	San Diego County
302686	Non-Physician Medical Practitioner	None	1982640298	0	0	JONES, AMY K	12/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480 VIA DEL PLANO	None	NOVATO	CA	94949	5969	00	06000	38.06731633	-122.550666	Marin County
302726	Non-Physician Medical Practitioner	None	1093815847	0	0	JAVADI KHOMAMI, JAVAD	11/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5541 MOSSVALE CIR	None	HUNTINGTON BEACH	CA	92649	4824	00	06000	33.7077034	-118.0316219	Orange County
302787	Non-Physician Medical Practitioner	None	1932742855	0	0	JONES, BRITTANY E PA	5/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1427 MAGNOLIA AVE	None	CHICO	CA	95926	3226	00	06000	39.74063543	-121.8499003	Butte County
302796	Non-Physician Medical Practitioner	None	1760808240	0	0	JUN, JAYSON C NP	8/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 W AVENUE 26	UNIT 345	LOS ANGELES	CA	90031	1489	00	06000	34.08086215	-118.2194952	Los Angeles County
302817	Non-Physician Medical Practitioner	None	1760426399	0	0	JOHNSON, ROBERT LAWRENCE	5/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	00	06000	39.13286634	-121.6142652	Sutter County
302896	Non-Physician Medical Practitioner	None	1568472264	0	0	JONES, MARVIN D	11/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4857 W REESE AVE	None	VISALIA	CA	93277	0622	00	06000	36.291285	-119.344509	Tulare County
302905	Non-Physician Medical Practitioner	None	1518454396	0	0	JIN, YUCHAO 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	29798 HAUN ROAD	SUITE 301	MENIFEE	CA	92586	6541	00	06000	33.68787713	-117.1748638	Riverside County
302969	Non-Physician Medical Practitioner	None	1952347627	0	0	JONES, CHERLYNN RENEE	1/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6051 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	5496	00	06000	34.10168352	-118.321686	Los Angeles County
303029	Non-Physician Medical Practitioner	None	1245941301	0	0	JUMBA, RICHARD N	2/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	00	06000	34.51312455	-117.325854	San Bernardino County
303153	Non-Physician Medical Practitioner	None	1245783224	0	0	JOSEPH, BEN NP	4/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
303156	Non-Physician Medical Practitioner	None	1447814652	0	0	JIVAN, ELIZABETH P PA-C	9/15/2020	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
303214	Non-Physician Medical Practitioner	None	1467698811	0	0	JUBB, SONYA CNM	8/28/2017	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
303227	Non-Physician Medical Practitioner	None	1518310333	0	0	JEREMIAH, GASTON PA	12/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
303240	Non-Physician Medical Practitioner	None	1962010793	0	0	JOHNSON, ALEXANDRIA C NP	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	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	00	06000	39.13286634	-121.6142652	Sutter County
303253	Non-Physician Medical Practitioner	None	1215531165	0	0	JOHNSON, ALLISON CNP	4/10/2023	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 CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
303409	Non-Physician Medical Practitioner	None	1679064562	0	0	JENNRICH, PHILLIP A	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22676 DUNKENFIELD CIRCLE	None	LAKE FOREST	CA	92630	4616	00	06000	33.63370642	-117.6850605	Orange County
303497	Non-Physician Medical Practitioner	None	1396389334	0	0	JOHANSEN, COLLIN J PA	8/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
303510	Non-Physician Medical Practitioner	None	1912458753	0	0	JOU-ZHANG, ROSA K	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	3149 CASA DE CAMPO	APT 204	SAN MATEO	CA	94403	2122	00	06000	37.54283675	-122.2837265	San Mateo County
303533	Non-Physician Medical Practitioner	None	1740302413	0	0	JOBE, MARISSA P PA	12/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	00	06000	34.42739162	-119.7253175	Santa Barbara County
303545	Non-Physician Medical Practitioner	None	1639859044	0	0	JUNG, CASSIDY M PA-C	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	21250 HAWTHORNE BLVD	SUITE 430	TORRANCE	CA	90503	5506	00	06000	33.83566432	-118.3531683	Los Angeles County
303556	Non-Physician Medical Practitioner	None	1346303484	0	0	JUNG, JULIE M	1/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3886 GLENGROVE WAY	None	SAN JOSE	CA	95123	1707	00	06000	37.29942233	-121.7988335	Santa Clara County
303623	Non-Physician Medical Practitioner	None	1043263452	0	0	JOHNSON, WANDA HARRIETTE	5/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10700 MACARTHUR BLVD	EAST OAKLAND CLINIC, SUI	OAKLAND	CA	94605	5260	00	06000	37.74201242	-122.151048	Alameda County
303737	Non-Physician Medical Practitioner	None	1043515414	0	0	JACOBS, ABBY J MD	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	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303758	Non-Physician Medical Practitioner	None	1154508430	0	0	JOHANNES, EDITH G 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	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
303774	Non-Physician Medical Practitioner	None	1336212547	0	0	JONAS, SUSAN ELIZABETH	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	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	00	06000	38.644479	-121.1349735	Sacramento County
303812	Non-Physician Medical Practitioner	None	1750916094	0	0	JOOSTEN, MONICA M NP	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	306 N CONYER ST	None	VISALIA	CA	93291	4704	00	06000	36.332487	-119.300895	Tulare County
303818	Non-Physician Medical Practitioner	None	1376071092	0	0	JACKSON, LINDA C 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	13866 CASABLANCA CT	None	CORONA	CA	92880	8515	00	06000	33.95153017	-117.5858243	Riverside County
303850	Non-Physician Medical Practitioner	None	1346223757	0	0	JORDAN, NAITTE P NP	1/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1224 W ROSENBURG AVE	APT A	MODESTO	CA	95350	4968	00	06000	37.66035951	-121.010789	Stanislaus County
303931	Non-Physician Medical Practitioner	None	1922728286	0	0	JORGENSEN, AUBREY J NP	2/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9508 STOCKDALE HWY	SUITE 150	BAKERSFIELD	CA	93311	3622	00	06000	35.35453237	-119.1086014	Kern County
304000	Non-Physician Medical Practitioner	None	1932359940	0	0	JACOBS, JESSICA S	3/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5383 OGAN RD	None	CARPINTERIA	CA	93013	1546	00	06000	34.39993121	-119.5081361	Santa Barbara County
304019	Non-Physician Medical Practitioner	None	1285754762	0	0	JACHNIEWICZ, BARBARA	10/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	CYPRESS BUILDING , SUIT	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
304099	Non-Physician Medical Practitioner	None	1346359866	0	0	JACOBS, MARK	8/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	600 SW COLLEGE AVE	SUITE 202	TOPEKA	KS	66606	1684	00	06000	39.0575492	-95.69824945	Shawnee County
304115	Non-Physician Medical Practitioner	None	1467010744	0	0	JEPSON, JORDAN J PA	3/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 DELBON AVE	STE 8	TURLOCK	CA	95382	2008	00	06000	37.51054507	-120.8367636	Stanislaus County
304247	Non-Physician Medical Practitioner	None	1861908873	0	0	JALALI, NOOSHIN NP	3/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	00	06000	36.60784193	-119.4520057	Fresno County
304305	Non-Physician Medical Practitioner	None	1013586999	0	0	JOHANIS, ANJANA NP	2/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
304317	Non-Physician Medical Practitioner	None	1679136832	0	0	JONES, MEGHAN E NP	6/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
304438	Non-Physician Medical Practitioner	None	1326518945	0	0	JOSEPH, SHARON E NP	11/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	00	06000	36.7796958	-119.7618088	Fresno County
304458	Non-Physician Medical Practitioner	None	1538564216	0	0	JOOS, LAUREN PA	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 CREEKSIDE DRIVE	None	FOLSOM	CA	95630	3400	00	06000	38.67021	-121.145382	Sacramento County
304550	Non-Physician Medical Practitioner	None	1801811997	0	0	JOHNSON, KWENDA K PA-C	6/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2395 LOMBARD ST	None	SAN FRANCISCO	CA	94123	2601	00	06000	37.79922688	-122.4406853	San Francisco County
304655	Non-Physician Medical Practitioner	None	1578074035	0	0	JIANG, YAN	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	248 N ADLER AVENUE	None	CLOVIS	CA	93612	0187	00	06000	36.83487169	-119.7250254	Fresno County
304711	Non-Physician Medical Practitioner	None	1851325369	0	0	JORDAN, LINDA C	5/10/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BROADWAY ST	STANFORD ORTHOPEDIC ONCO	REDWOOD CITY	CA	94063	3132	00	06000	37.48523183	-122.2025998	San Mateo County
304722	Non-Physician Medical Practitioner	None	1508599424	0	0	JEPSEN, KELSEY A CNP	9/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11100 WARNER AVE	STE 368	FOUNTAIN VALLEY	CA	92708	7514	00	06000	33.716291	-117.9355051	Orange County
304729	Non-Physician Medical Practitioner	None	1871855114	0	0	JANG, ELAINE NP	6/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3671 ROCKY SHORE CT	None	VALLEJO	CA	94591	6349	00	06000	38.1283313	-122.2056909	Solano County
304890	Non-Physician Medical Practitioner	None	1306921150	0	0	JAEGER, JENNIFER MARIE	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
304922	Non-Physician Medical Practitioner	None	1508842725	0	0	JONES, WILLIAM D JR	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	929 E FOXHILL DR	None	FRESNO	CA	93720	1220	00	06000	36.86730609	-119.7662086	Fresno County
305093	Non-Physician Medical Practitioner	None	1033695184	0	0	JOHNSON, HEIDI L NP	12/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
305152	Non-Physician Medical Practitioner	None	1033442165	0	0	JOVANOV, CYNTHIA NP	11/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33800 WILLOWHAVEN LANE	APT 102	MURRIETA	CA	92563	3443	00	06000	33.63133234	-117.1672917	Riverside County
305194	Non-Physician Medical Practitioner	None	1699296095	0	0	JONES, DYLAN F CA	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
305228	Non-Physician Medical Practitioner	None	1730692500	0	0	JASKOT, MICHAEL PA-C	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	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	00	06000	38.91323462	-119.9965999	El Dorado County
305266	Non-Physician Medical Practitioner	None	1356921803	0	0	JENKINS, MONICA NP	4/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 TERRACINA BLVD	SUITE 202	REDLANDS	CA	92373	4870	00	06000	34.03788441	-117.2055761	San Bernardino County
305287	Non-Physician Medical Practitioner	None	1710023858	0	0	JONES, DENISE SUZANNE	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	2245 GEARY STREET	None	SAN FRANCISCO	CA	94115	0000	00	06000	37.78305731	-122.4403651	San Francisco County
305300	Non-Physician Medical Practitioner	None	1770515769	0	0	JOSEPH, MILDRED P NP	10/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5804 W CHENNAULT AVE	None	FRESNO	CA	93722	2650	00	06000	36.84189688	-119.896392	Fresno County
305360	Non-Physician Medical Practitioner	None	1699036756	0	0	JACKSON, IVETTE S NP	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	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305362	Non-Physician Medical Practitioner	None	1447622477	0	0	JACOBS, MADELINE F NP	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1953 NW IRVING STREET	APT 205	PORTLAND	OR	97209	1240	00	06000	45.52781178	-122.6916576	Multnomah County
305473	Non-Physician Medical Practitioner	None	1083043210	0	0	JOHNS, JOEI H PA-C	5/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	None	SACRAMENTO	CA	95816	3300	00	06000	38.579877	-121.456143	Sacramento County
305489	Non-Physician Medical Practitioner	None	1346679917	0	0	JACOBS, JEANETTE R NP	2/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1050 PINERIDGE DR	None	RENO	NV	89509	3628	00	06000	39.50214044	-119.8250072	Washoe County
305543	Non-Physician Medical Practitioner	None	1083934855	0	0	JESRANI, LENA B NP	2/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2964 MAHASKA WAY	None	SACRAMENTO	CA	95835	1802	00	06000	38.664639	-121.5283185	Sacramento County
305566	Non-Physician Medical Practitioner	None	1306958236	0	0	JOHNSON, SARAH R PA	10/1/2013	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
305585	Non-Physician Medical Practitioner	None	1114972478	0	0	JAMES, JASON TOBIAS	3/8/2012	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	4404	00	06000	37.66508443	-120.9962589	Stanislaus County
305602	Non-Physician Medical Practitioner	None	1134397508	0	0	JOURNEL, CHLOE LUU	8/24/2009	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 STE 3554	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
305618	Non-Physician Medical Practitioner	None	1033528385	0	0	JAMAL, ALA Z	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 GIBSON DR	2613	ROSEVILLE	CA	95678	5416	00	06000	38.77821669	-121.2743893	Placer County
305624	Non-Physician Medical Practitioner	None	1396401071	0	0	JOHN SUNDARRAJ, AMUTHAVALLI ATH MERC	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	00	06000	37.24572659	-121.957997	Santa Clara County
305669	Non-Physician Medical Practitioner	None	1407434509	0	0	JOHNSON, LINDSEY A PA	4/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
305696	Non-Physician Medical Practitioner	None	1275929879	0	0	JIMMERSON, CATHERINE E NP	5/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1350 S DIAMOND BAR BLVD	UNIT B	DIAMOND BAR	CA	91765	5463	00	06000	33.99771451	-117.8128623	Los Angeles County
305732	Non-Physician Medical Practitioner	None	1861059784	0	0	JACKSON, SEAN M PA-C	1/2/2020	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
305744	Non-Physician Medical Practitioner	None	1861745606	0	0	JWCH INSTITUTE INC.	2/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3580 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2602	00	06000	33.93044434	-118.2058277	Los Angeles County
305819	Non-Physician Medical Practitioner	None	1548443872	0	0	JERWERS, ALLISON B NP	12/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 17TH ST	None	SACRAMENTO	CA	95818	3834	00	06000	38.550978	-121.4949465	Sacramento County
305833	Non-Physician Medical Practitioner	None	1558044644	0	0	JACKSON, KELLEY J 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	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	00	06000	38.7257686	-120.7910663	El Dorado County
305842	Non-Physician Medical Practitioner	None	1134749922	0	0	JACOBSON, MCKENZIE L PA	1/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
305998	Non-Physician Medical Practitioner	None	1710522941	0	0	JAGIELLO, JEFFREY PA-C	6/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
306017	Non-Physician Medical Practitioner	None	1679939342	0	0	JOHNSON, JEREMY M	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	121 EAST ROUTE 66	APT 116	GLENDORA	CA	91740	6213	00	06000	34.1288365	-117.862821	Los Angeles County
306044	Non-Physician Medical Practitioner	None	1275971079	0	0	JARMAN, BRIAN K	3/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4905 N BERKELEY ST	None	SAN BERNARDINO	CA	92407	3015	00	06000	34.17299572	-117.2978717	San Bernardino County
306119	Non-Physician Medical Practitioner	None	1760683908	0	0	JACOBY, KATHERINE L NP	3/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ENCORE CT	None	NEWPORT BEACH	CA	92563	2356	00	06000	33.62457492	-117.937144	Orange County
306156	Non-Physician Medical Practitioner	None	1205328382	0	0	JOHNSON, DARREN K NP	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	601 EL DORADO ST	None	KINGMAN	AZ	86401	6224	00	06000	35.194698	-114.036273	Mohave County
306189	Non-Physician Medical Practitioner	None	1295005015	0	0	JONES, LESLIE A	11/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8152 LEA FOREST WAY	None	FAIR OAKS	CA	95628	2753	00	06000	38.667537	-121.259052	Sacramento County
306211	Non-Physician Medical Practitioner	None	1164665311	0	0	JOSE, JESSIL K NP	7/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1528 EUREKA RD	102	ROSEVILLE	CA	95661	3047	00	06000	38.748654	-121.2510645	Placer County
306240	Non-Physician Medical Practitioner	None	1548546336	0	0	JEPSON, ERIN	4/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1431 MCHENRY AVE	STE 100	MODESTO	CA	95350	4534	00	06000	37.664811	-120.993969	Stanislaus County
306248	Non-Physician Medical Practitioner	None	1447314836	0	0	JASTROW, LIZA M	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	1235 PARKINGTON AVENUE	UNIT 3	SUNNYVALE	CA	94087	1576	00	06000	37.36960513	-122.0583106	Santa Clara County
306265	Non-Physician Medical Practitioner	None	1912941600	0	0	JUACHON, JED J	6/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14510 CYPRESS POINT TERR	None	VALLEY CENTER	CA	92082	6670	00	06000	33.20623324	-117.0162742	San Diego County
306296	Non-Physician Medical Practitioner	None	1588493787	0	0	JOHNSON, KRISTINE	3/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
306530	Non-Physician Medical Practitioner	None	1700224011	0	0	JACKSON, TITUS C	3/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4216 DON CARLOS DRIVE	None	LOS ANGELES	CA	90008	2818	00	06000	34.00934043	-118.3559596	Los Angeles County
306579	Non-Physician Medical Practitioner	None	1417290917	0	0	JERNIGAN, KELLY E PA-C	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
306595	Non-Physician Medical Practitioner	None	1689336844	0	0	JUNG, SOO J NP	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
306598	Non-Physician Medical Practitioner	None	1386176774	0	0	JUNG, HYEEUN NP	1/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 N RIVERSIDE AVE	SUITE 210	RIALTO	CA	92376	8071	00	06000	34.132905	-117.3704675	San Bernardino County
306599	Non-Physician Medical Practitioner	None	1669704003	0	0	JEFFREY, ZACHARY	4/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
306613	Non-Physician Medical Practitioner	None	1447911284	0	0	JUNG, HANNA 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
306641	Non-Physician Medical Practitioner	None	1770251993	0	0	JOHNSON, GUNNAR E PA-C	3/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	00	06000	37.36893518	-122.0779448	Santa Clara County
306685	Non-Physician Medical Practitioner	None	1710431853	0	0	JUSTUS, JUDY N PA	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	1245 WILSHIRE BLVD	STE 707	LOS ANGELES	CA	90017	4807	00	06000	34.05362775	-118.2661889	Los Angeles County
306704	Non-Physician Medical Practitioner	None	1205377306	0	0	JONES, JORDAN PA-C	5/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
306797	Non-Physician Medical Practitioner	None	1598909103	0	0	JIMENEZ, ANA M PA	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
306803	Non-Physician Medical Practitioner	None	1750843629	0	0	JEE, COURTNEY PA-C	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	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	00	06000	38.406888	-121.4100495	Sacramento County
306811	Non-Physician Medical Practitioner	None	1265990006	0	0	JAMES, KIRA NP	8/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
306844	Non-Physician Medical Practitioner	None	1629498928	0	0	JOHNSON, MAKENSIE B	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	1900 VOORHEES AVENUE	UNIT C	REDONDO BEACH	CA	90278	2327	00	06000	33.87655244	-118.3795481	Los Angeles County
306927	Non-Physician Medical Practitioner	None	1063836120	0	0	JOSEPH, SHARY NP	4/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 N GLENVIEW AVE	None	ANAHEIM HILLS	CA	92807	1007	00	06000	33.86776074	-117.8133367	Orange County
306973	Non-Physician Medical Practitioner	None	1760844732	0	0	JADIN, SARAH PA-C	4/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8628 RESEDA BLVD.	None	NORTHRIDGE	CA	91324	4032	00	06000	34.22722956	-118.5360495	Los Angeles County
306974	Non-Physician Medical Practitioner	None	1548040405	0	0	JUAT, KATRINA CLARISSE P NP	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	15203 11TH ST	SUITE C	VICTORVILLE	CA	92395	3737	00	06000	34.52758919	-117.2925085	San Bernardino County
307172	Non-Physician Medical Practitioner	None	1831247725	0	0	JACKSON, RONALD JR	3/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17041 HIDDEN TRAILS LN	None	RIVERSIDE	CA	92503	6799	00	06000	33.87205636	-117.4430167	Riverside County
307173	Non-Physician Medical Practitioner	None	1114044492	0	0	JARAMILLO, LOUIS S	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	2651 N FAIRMONT AVE	None	SANTA ANA	CA	92705	6725	00	06000	33.77293333	-117.8573817	Orange County
307201	Non-Physician Medical Practitioner	None	1336524099	0	0	JEZIERSKI, ASHLEY A	3/29/2024	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
307237	Non-Physician Medical Practitioner	None	1033638168	0	0	JOHNSON, LAURALIE C NP	4/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1107 FAIR OAKS AVE	SUITE 299	SOUTH PASADENA	CA	91030	3311	00	06000	34.11342628	-118.1504409	Los Angeles County
307239	Non-Physician Medical Practitioner	None	1679908362	0	0	JARRARD, JASMINE M PA-C	7/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1085 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2405	00	06000	37.75563342	-122.4209694	San Francisco County
307250	Non-Physician Medical Practitioner	None	1154609790	0	0	JARVIS, KELLY C PA-C	11/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
307264	Non-Physician Medical Practitioner	None	1699786269	0	0	JUNCAJ, LUIGI P	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	645 WEST 9TH STREET	UNIT 629	LOS ANGELES	CA	90015	1055	00	06000	34.0454919	-118.2608885	Los Angeles County
307298	Non-Physician Medical Practitioner	None	1255872719	0	0	JOHNSON, SIBONISIWE M NP	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	22555 ALESSANDRO BLVD	STE B	MORENO VALLEY	CA	92553	8533	00	06000	33.9169235	-117.2693745	Riverside County
307382	Non-Physician Medical Practitioner	None	1881276301	0	0	JOHNSON, SUZANNE L NP	12/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
307432	Non-Physician Medical Practitioner	None	1326527045	0	0	JACKSON, KEITH A PA-C	10/26/2018	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	4TH FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
307482	Non-Physician Medical Practitioner	None	1760495535	0	0	JOLLY, JAMES J NP	6/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	224 SEAVIEW	None	SHELL BEACH	CA	93449	2044	00	06000	35.15378685	-120.6676237	San Luis Obispo County
307512	Non-Physician Medical Practitioner	None	1023744695	0	0	JONES, DAVID M PA	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
307517	Non-Physician Medical Practitioner	None	1104276419	0	0	JONES, TYESHIA M 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	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	00	06000	34.52471945	-117.3042336	San Bernardino County
307555	Non-Physician Medical Practitioner	None	1316322837	0	0	JONES, JACIE A 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	2265 RIVER PLAZA DR	APT 409	SACRAMENTO	CA	95833	4125	00	06000	38.606085	-121.5170595	Sacramento County
307602	Non-Physician Medical Practitioner	None	1043376718	0	0	JORDAN, DANIEL W	9/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4901 PICO AVE	None	BAKERSFIELD	CA	93306	3119	00	06000	35.39039801	-118.9493865	Kern County
307613	Non-Physician Medical Practitioner	None	1356504203	0	0	JOSEPHINE, CLEMENTS C	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
307628	Non-Physician Medical Practitioner	None	1366761322	0	0	JAKOBS, VIVIANNE NP	10/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25405 HANCOCK AVE	SUITE 203	MURRIETA	CA	92562	5978	00	06000	33.5580833	-117.1850127	Riverside County
307647	Non-Physician Medical Practitioner	None	1790479681	0	0	JEONG, DANA PA-C	2/22/2025	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
307676	Non-Physician Medical Practitioner	None	1033758578	0	0	JAYADEVAN, SYAMJITH NP	1/31/2023	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
307746	Non-Physician Medical Practitioner	None	1982613774	0	0	JAIR, DEBORAH P	4/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8612 LAGO DI COMO LANE	None	BAKERSFIELD	CA	93312	1966	00	06000	35.40073934	-119.0985424	Kern County
307766	Non-Physician Medical Practitioner	None	1558537118	0	0	JANG, JIHYUN NP	8/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5201 LINCOLN AVE	None	CYPRESS	CA	90630	2965	00	06000	33.83180488	-118.0419207	Orange County
307789	Non-Physician Medical Practitioner	None	1780152165	0	0	JUNG, YOOJIN NP	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
307888	Non-Physician Medical Practitioner	None	1447830849	0	0	JONES, DEXTER A NP	7/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
307937	Non-Physician Medical Practitioner	None	1699198051	0	0	JERNIGAN, MARIA S PA	12/27/2017	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
308035	Non-Physician Medical Practitioner	None	1225523665	0	0	JACKSON, DAVID S	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10000 SW 52ND AVENUE	BB170	GAINSVILLE	FL	32608	8303	00	06000	29.60676534	-82.45011845	Alachua County
308096	Non-Physician Medical Practitioner	None	1235669409	0	0	JOY, LISA M NP	10/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6994 E MICHIGAN AVE	None	CLOVIS	CA	93727	1443	00	06000	36.77709339	-119.6647937	Fresno County
308210	Non-Physician Medical Practitioner	None	1144650631	0	0	JAVAHERIFAR, SAMIRA NP	7/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1620 S HOOVER ST	SUITE B	LOS ANGELES	CA	90006	4910	00	06000	34.043076	-118.284114	Los Angeles County
308220	Non-Physician Medical Practitioner	None	1548385172	0	0	JAMIL-CLOVIS, RITA	2/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4134 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1610	00	06000	32.7520774	-117.1009072	San Diego County
308293	Non-Physician Medical Practitioner	None	1316332547	0	0	JAUREGUI, MONIKA E NP	11/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14860 ORANGE GROVE AVE	None	HACIENDA HEIGHTS	CA	91745	3243	00	06000	34.00699443	-117.9884698	Los Angeles County
308303	Non-Physician Medical Practitioner	None	1568744027	0	0	JEFFCOACH, KRICHELE A	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	715 E ALLUVIAL	None	FRESNO	CA	93720	2514	00	06000	36.84397152	-119.7721294	Fresno County
308317	Non-Physician Medical Practitioner	None	1790432185	0	0	JOANIS, DOROTHY NP	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	00	06000	34.2214515	-118.4573205	Los Angeles County
308318	Non-Physician Medical Practitioner	None	1245900687	0	0	JONES, CRAIG A PA-C	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	315 SOUTH TUSTIN ST	None	ORANGE	CA	92866	2501	00	06000	33.783957	-117.835721	Orange County
308343	Non-Physician Medical Practitioner	None	1033522461	0	0	JOHNSON, TRENICE 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	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
308376	Non-Physician Medical Practitioner	None	1275534562	0	0	JUNCKER, MELISSA A	2/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1360 9TH AVE	APT 6	SAN FRANCISCO	CA	94122	2374	00	06000	37.76290019	-122.4662021	San Francisco County
308433	Non-Physician Medical Practitioner	None	1851755532	0	0	JAVIER, XYRWYN MAE G NP	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
308469	Non-Physician Medical Practitioner	None	1013074004	0	0	JEFFREY, JAMES F PA-C	9/30/2021	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
308477	Non-Physician Medical Practitioner	None	1730351636	0	0	JONES, MARY JEAN	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	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	00	06000	38.91235444	-119.996422	El Dorado County
308560	Non-Physician Medical Practitioner	None	1699939660	0	0	JOSHUA, SANJEEV	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
308664	Non-Physician Medical Practitioner	None	1982893566	0	0	JESSEN, JENNIFER ANN	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	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
308741	Non-Physician Medical Practitioner	None	1982718227	0	0	JAFFE, DENISE ANN	7/29/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11645 WILSHIRE BLVD	SUITE 1155	LOS ANGELES	CA	90025	1708	00	06000	34.05005135	-118.4602303	Los Angeles County
308901	Non-Physician Medical Practitioner	None	1851786024	0	0	JORDAN, SARAH B NP	3/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
308914	Non-Physician Medical Practitioner	None	1801427448	0	0	JACKSON, KALYSE D NP	12/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7900 PACIFIC BLVD	SUITE C AND D	WALNUT PARK	CA	90255	6662	00	06000	33.966414	-118.2251935	Los Angeles County
308981	Non-Physician Medical Practitioner	None	1487106225	0	0	JAMADAR, ROSHNI R	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11845 SPRUCE RUN DR	APT B	SAN DIEGO	CA	92131	4737	00	06000	32.93409973	-117.0875866	San Diego County
308996	Non-Physician Medical Practitioner	None	1710413208	0	0	JOHNSON WHITE, JHAUREL NP	6/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
309013	Non-Physician Medical Practitioner	None	1932208451	0	0	JUDSON, JANICE C	3/10/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9281 OFFICE PARK CIR	#120	ELK GROVE	CA	95758	8068	00	06000	38.418264	-121.39641	Sacramento County
309033	Non-Physician Medical Practitioner	None	1699163840	0	0	JONES, CHARLOTTE L NP	2/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 LOWER RAGSDALE	160	MONTEREY	CA	93940	5748	00	06000	36.5766066	-121.8193801	Monterey County
309082	Non-Physician Medical Practitioner	None	1831295484	0	0	JAMES, AMANDA B NP	6/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	121 FLAME TREE RD	None	BURNT RANCH	CA	95527	0000	00	06000	40.8763368	-123.5159897	Trinity County
309105	Non-Physician Medical Practitioner	None	1861448029	0	0	JOHNSON, SHANNON KATHLEEN	6/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	329 W. 8TH STREET	SUITE 101	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
309135	Non-Physician Medical Practitioner	None	1578848495	0	0	JONES, SEPHANIE J	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2546 ASSOCIATED ROAD	10	FULLERTON	CA	92835	3262	00	06000	33.8964319	-117.8845726	Orange County
309136	Non-Physician Medical Practitioner	None	1245396092	0	0	JIMENEZ, PATRICIA DELCARMEN	10/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1718 HOLLYVISTA AVE	None	LOS ANGELES	CA	90027	4626	00	06000	34.10112376	-118.2771509	Los Angeles County
309138	Non-Physician Medical Practitioner	None	1962810440	0	0	JONES, DIANE A	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	16350 VENTURA BLVD	APT 247	ENCINO	CA	91436	5307	00	06000	34.15710102	-118.489263	Los Angeles County
309217	Non-Physician Medical Practitioner	None	1578962726	0	0	JONES, SUSANN E	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	745 N PASADENA AVE	UNIT 1	PASADENA	CA	91103	3233	00	06000	34.15713427	-118.1599737	Los Angeles County
309260	Non-Physician Medical Practitioner	None	1063585099	0	0	JANNESARI, ROYA	4/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 W EL NORTE PKWY	SUITE 201	ESCONDIDO	CA	92026	3923	00	06000	33.14611822	-117.1023285	San Diego County
309270	Non-Physician Medical Practitioner	None	1831495944	0	0	JARAMILLO, CARLOS	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	1177 BRANHAM LN	APT 267	SAN JOSE	CA	95118	3766	00	06000	37.26238551	-121.8791709	Santa Clara County
309302	Non-Physician Medical Practitioner	None	1346914538	0	0	JOHNSON, LILY S PA	9/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
309348	Non-Physician Medical Practitioner	None	1487986949	0	0	JIANG, LEI	7/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	878 LUZ DEL SOL LOOP	None	MILPITAS	CA	95035	8671	00	06000	37.42071524	-121.9114421	Santa Clara County
309386	Non-Physician Medical Practitioner	None	1508151572	0	0	JOHNSON, DANIEL S PA-C	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
309502	Non-Physician Medical Practitioner	None	1215663885	0	0	JANINI, RANEEN PA	2/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16167 SISKIYOU ROAD	SUITE A	APPLE VALLEY	CA	92307	0837	00	06000	34.54496692	-117.2664417	San Bernardino County
309556	Non-Physician Medical Practitioner	None	1316161375	0	0	JIMENEZ-ENGLISH, MARIA L NP	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	21380 VIA DEL PARQUE	None	YORBA LINDA	CA	92887	2561	00	06000	33.8813432	-117.7582997	Orange County
309562	Non-Physician Medical Practitioner	None	1275141657	0	0	JOHNSTON, KORI ANN E NP	11/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
309584	Non-Physician Medical Practitioner	None	1144473463	0	0	JOHNSON, LORI F NP	11/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	00	06000	38.24451673	-122.6303052	Sonoma County
309612	Non-Physician Medical Practitioner	None	1578206835	0	0	JONES, KAITLYN	4/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73345 HIGHWAY 111	STE 202	PALM DESERT	CA	92260	4215	00	06000	33.72092199	-116.384896	Riverside County
309653	Non-Physician Medical Practitioner	None	1023723061	0	0	JAIMEZ, JESSICA N 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	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	00	06000	36.359649	-119.331567	Tulare County
309763	Non-Physician Medical Practitioner	None	1477024370	0	0	JOHNSON, KIMBERLY A NP	9/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	429 BROADWAY	None	CHULA VISTA	CA	91910	4413	00	06000	32.63325568	-117.0903455	San Diego County
309787	Non-Physician Medical Practitioner	None	1003236282	0	0	JACOBSMEYER, WHITNEY A	6/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1525 N ASCIANO CT	None	VISALIA	CA	93291	9706	00	06000	36.342837	-119.3464665	Tulare County
309828	Non-Physician Medical Practitioner	None	1174920060	0	0	JIANG, TING T NP	12/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	70 JADE TREE CIR	None	SACRAMENTO	CA	95834	3801	00	06000	38.637045	-121.511826	Sacramento County
309885	Non-Physician Medical Practitioner	None	1043734908	0	0	JACOBSON, AUBREY S	4/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	00	06000	33.62579141	-117.9299554	Orange County
310019	Non-Physician Medical Practitioner	None	1508322462	0	0	JOHNSON, CHARLOTTE 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	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	00	06000	38.421054	-121.405365	Sacramento County
310043	Non-Physician Medical Practitioner	None	1437789898	0	0	JAENA, ELIZABETH CNP	2/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	915 W 7TH ST	None	OXNARD	CA	93030	5766	00	06000	34.19516388	-119.1889217	Ventura County
310094	Non-Physician Medical Practitioner	None	1134897002	0	0	JOHNSON, KATHRYN PA-C	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	06000	42.25288307	-121.7896138	Klamath County
310124	Non-Physician Medical Practitioner	None	1205069234	0	0	JACK, JAMES KYLE	7/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1555 SPRINGFIELD DR	None	CHICO	CA	95928	6398	00	06000	39.73089101	-121.8089267	Butte County
310226	Non-Physician Medical Practitioner	None	1790907764	0	0	JACKSON, KATHRYN LANO	4/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 NUT TREE RD	SUITE 140	VACAVILLE	CA	95687	3508	00	06000	38.36441975	-121.9525909	Solano County
310257	Non-Physician Medical Practitioner	None	1902077183	0	0	JAHNS, FRANCESCA Y	6/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6008 SCOTMIST DRIVE	None	RANCHO PALOS VERD	CA	90275	3349	00	06000	33.77448459	-118.3844017	Los Angeles County
310295	Non-Physician Medical Practitioner	None	1720113079	0	0	JIMENEZ, VICTOR F	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	2381 W 23RD ST	None	LOS ANGELES	CA	90018	1308	00	06000	34.03597647	-118.3171995	Los Angeles County
310323	Non-Physician Medical Practitioner	None	1891169397	0	0	JARICK, JOCELYN	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	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	00	06000	38.55304251	-121.5367185	Yolo County
310337	Non-Physician Medical Practitioner	None	1710506472	0	0	JACKSON, SHANNA S NP	2/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24060 FIR AVE	SUITE A	MORENO VALLEY	CA	92553	2895	00	06000	33.93543049	-117.242604	Riverside County
310431	Non-Physician Medical Practitioner	None	1578002077	0	0	JORDAN, NICHOLAS E	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	445 S WALTON AVE	None	YUBA CITY	CA	95993	5205	00	06000	39.12091007	-121.6438988	Sutter County
310487	Non-Physician Medical Practitioner	None	1033362892	0	0	JULIUSSON, SUSAN N NP	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
310494	Non-Physician Medical Practitioner	None	1841751104	0	0	JOSHI, POONAM S PA	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	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	00	06000	35.29325417	-120.667547	San Luis Obispo County
310522	Non-Physician Medical Practitioner	None	1124048764	0	0	JOHNSON, LINDA A NP	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	29640 THE HORSESHOE	None	WINTERS	CA	95694	9025	00	06000	38.507697	-122.0079285	Yolo County
310534	Non-Physician Medical Practitioner	None	1740633973	0	0	JOORABCHI, NISA 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
310570	Non-Physician Medical Practitioner	None	1134355324	0	0	JULIEN, KAREN A	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	00	06000	34.06169385	-118.2044698	Los Angeles County
310596	Non-Physician Medical Practitioner	None	1457880510	0	0	JOHNSON, AUTUMN L PA	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	1220 W HEMLOCK WAY	STE 204	SANTA ANA	CA	92707	3655	00	06000	33.70975375	-117.8842792	Orange County
310612	Non-Physician Medical Practitioner	None	1013191840	0	0	JUSAY, PAULO N	5/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8592 HAZELNUT STREET	None	BUENA PARK	CA	90620	3033	00	06000	33.84158016	-117.9832627	Orange County
310630	Non-Physician Medical Practitioner	None	1982423703	0	0	JAMES, JACQUELINE E NP	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
310661	Non-Physician Medical Practitioner	None	1225261027	0	0	JESKE, DON W	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	17330 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	7741	00	06000	34.47105684	-117.2841999	San Bernardino County
310719	Non-Physician Medical Practitioner	None	1205283736	0	0	JACOBS, DREW C	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	15327 BRAUN CT	None	MOORPARK	CA	93021	3216	00	06000	34.30630018	-118.8427717	Ventura County
310768	Non-Physician Medical Practitioner	None	1477085314	0	0	JOINER, KIMBERLY M NP	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
310776	Non-Physician Medical Practitioner	None	1851719678	0	0	JAMES, TRAM H NP	8/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1304 FITCH WAY	None	SACRAMENTO	CA	95864	3031	00	06000	38.588445	-121.3692975	Sacramento County
310786	Non-Physician Medical Practitioner	None	1306555149	0	0	JAMES, SKYLAR G PA	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	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	00	06000	39.15305697	-123.2037774	Mendocino County
311020	Non-Physician Medical Practitioner	None	1770711459	0	0	JACKSON, DANIELLE LEENORA	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	630 DRAKE AVE	None	SAUSALITO	CA	94965	1107	00	06000	37.87340883	-122.515085	Marin County
311085	Non-Physician Medical Practitioner	None	1689343469	0	0	JOHNSON-FERNANDEZ, CHERYL A NP	9/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1321 COTTONWOOD ST	STE 203	WOODLAND	CA	95695	5131	00	06000	38.66479566	-121.7933418	Yolo County
311122	Non-Physician Medical Practitioner	None	1386992048	0	0	JENEI, KELLY C NP	9/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1714 TIERRA NUEVA LN	None	OCEANO	CA	93445	9126	00	06000	35.10148141	-120.597705	San Luis Obispo County
311147	Non-Physician Medical Practitioner	None	1588011035	0	0	JACKSON, GWENDOLYN M	6/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	00	06000	37.88758326	-122.1181419	Contra Costa County
311163	Non-Physician Medical Practitioner	None	1679585343	0	0	JAGADISH, MADHU PA-C	9/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1551 BISHOP ST	A 150	SAN LUIS OBISPO	CA	93401	4635	00	06000	35.27475609	-120.6454494	San Luis Obispo County
311214	Non-Physician Medical Practitioner	None	1184759649	0	0	JULTY, JACQUELINE PA-C	8/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27225 CALAROGA AVENUE	None	HAYWARD	CA	94545	4338	00	06000	37.63194474	-122.0897225	Alameda County
311264	Non-Physician Medical Practitioner	None	1740019231	0	0	JACOB, NANCY 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	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
311358	Non-Physician Medical Practitioner	None	1417657636	0	0	JACKSON, PAULINE	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	06000	36.28701289	-115.2877045	Clark County
311361	Non-Physician Medical Practitioner	None	1982181293	0	0	JIANG, JOHNNY Q PA-C	3/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 COLUMBUS AVE	SUITE 110	SAN FRANCISCO	CA	94133	5160	00	06000	37.79680499	-122.4050031	San Francisco County
311451	Non-Physician Medical Practitioner	None	1568802775	0	0	JUMP, JACKLYN H NP	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	2749 ORANGE AVE	None	LA CRESCENTA	CA	91214	2124	00	06000	34.23271277	-118.2391382	Los Angeles County
311462	Non-Physician Medical Practitioner	None	1154488765	0	0	JOSIAH-DAVIS, ERNA	2/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3850 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1502	00	06000	37.78587201	-122.4578677	San Francisco County
311508	Non-Physician Medical Practitioner	None	1750529426	0	0	JAVDANFAR, AZITA	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1125 S BEVERLY DR STE 40	None	LOS ANGELES	CA	90035	1152	00	06000	34.05696658	-118.3966613	Los Angeles County
311522	Non-Physician Medical Practitioner	None	1003307927	0	0	JOHNSTONE, ALAN NP	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 BROADWAY	STE 305	CHULA VISTA	CA	91911	2700	00	06000	32.60964123	-117.0809743	San Diego County
311583	Non-Physician Medical Practitioner	None	1851629315	0	0	JIN, HYUN J	3/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8490 HYDRA LN	None	SAN DIEGO	CA	92126	1855	00	06000	32.92055326	-117.1410001	San Diego County
311669	Non-Physician Medical Practitioner	None	1063054641	0	0	JIRAS, AILEEN P PA	3/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 LA VETA	STE 430	ORANGE	CA	92868	4226	00	06000	33.7802984	-117.8651669	Orange County
311730	Non-Physician Medical Practitioner	None	1598389215	0	0	JEWELL, ALEXANDRA K	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	3095 OLD CONEJO RD	SUITE 200	NEWBURY PARK	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
311817	Non-Physician Medical Practitioner	None	1700587938	0	0	JARAMISHIAN, ELYSE G 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	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
311819	Non-Physician Medical Practitioner	None	1215325337	0	0	JACOBO, MARCO A PA-C	5/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	00	06000	37.5239043	-122.2667778	San Mateo County
311895	Non-Physician Medical Practitioner	None	1982074548	0	0	JOHNSON, KATHRYN PA-C	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	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	00	06000	34.06215064	-117.9453997	Los Angeles County
311906	Non-Physician Medical Practitioner	None	1790172534	0	0	JIMENEZ, CHRISTINA A NP	3/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9792 SIERRA AVE	None	FONTANA	CA	92335	6717	00	06000	34.0757348	-117.4357502	San Bernardino County
311949	Non-Physician Medical Practitioner	None	1730454927	0	0	JONAITIS, SUSAN A	6/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5854 COLFAX AVENUE	None	N HOLLYWOOD	CA	91601	1013	00	06000	34.177311	-118.3877605	Los Angeles County
311974	Non-Physician Medical Practitioner	None	1336316025	0	0	JAUREGUI, VERONICA	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	2668 HEIL CIRCLE	None	EL CENTRO	CA	92243	3320	00	06000	32.78712046	-115.587855	Imperial County
312001	Non-Physician Medical Practitioner	None	1912216797	0	0	JAMES, GREGORY DAVID	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	400 PARNASSUS AVE	3RD FLOOR A311	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
312002	Non-Physician Medical Practitioner	None	1427759653	0	0	JANG, JUN HEE PA	1/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5363 BALBOA BLVD	STE 445	ENCINO	CA	91316	2844	00	06000	34.169058	-118.5011265	Los Angeles County
312020	Non-Physician Medical Practitioner	None	1841407798	0	0	JAFFER, RIAN NINA PA	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12565 HESPERIA RD	STE 3	VICTORVILLE	CA	92395	8318	00	06000	34.47971486	-117.2908434	San Bernardino County
312030	Non-Physician Medical Practitioner	None	1720127194	0	0	JOZWIAK, ERIN MARIE STEGE	11/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
312031	Non-Physician Medical Practitioner	None	1447857719	0	0	JOSEPH, STANLEY PA	4/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
312045	Non-Physician Medical Practitioner	None	1326413121	0	0	JOBE, CHERYL 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	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	00	06000	38.35581953	-121.9530257	Solano County
312100	Non-Physician Medical Practitioner	None	1720337587	0	0	JIRARI, LEILA R PA-C	5/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	156 SANDERLING LANE	None	GOLETA	CA	93117	2483	00	06000	34.43135847	-119.902007	Santa Barbara County
312111	Non-Physician Medical Practitioner	None	1649306457	0	0	JEAN-PIERRE, EMANUEL PA-C	5/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9390 HESPERIA RD	SUITE # 7	HESPERIA	CA	92345	3602	00	06000	34.4212584	-117.3021441	San Bernardino County
312237	Non-Physician Medical Practitioner	None	1982858072	0	0	JACOBO, HUBERTO N	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	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
312268	Non-Physician Medical Practitioner	None	1598411308	0	0	JAINARINE, CYNTHIA	1/13/2025	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
312314	Non-Physician Medical Practitioner	None	1255510053	0	0	JOY, DOLSTEIN M	7/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8010 FROST ST	2ND FLR	SAN DIEGO	CA	92123	2778	00	06000	32.80026879	-117.1520059	San Diego County
312319	Non-Physician Medical Practitioner	None	1972052132	0	0	JEREZ-AGUILAR, BRENDA L 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	11360 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3834	00	06000	34.04666844	-117.2436991	San Bernardino County
312338	Non-Physician Medical Practitioner	None	1255809372	0	0	JACKSON, EMMA J NP	6/27/2019	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
312366	Non-Physician Medical Practitioner	None	1962078048	0	0	JUAREZ, BENJAMIN PA-C	12/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
312412	Non-Physician Medical Practitioner	None	1033155452	0	0	JACKSON, DINA A	8/22/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2037 W BULLARD AVE	APT 135	FRESNO	CA	93711	1200	00	06000	36.82273653	-119.827575	Fresno County
312451	Non-Physician Medical Practitioner	None	1366779738	0	0	JORDAN, BARBARA A	1/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 PARKMOOR AVE	APT 3422	SAN JOSE	CA	95126	3577	00	06000	37.31676514	-121.9094073	Santa Clara County
312458	Non-Physician Medical Practitioner	None	1669985974	0	0	JAIME, IRIANA S NP	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	2029 E CHRISTENSEN DR	None	FRESNO	CA	93730	3425	00	06000	36.89468794	-119.7464513	Fresno County
312536	Non-Physician Medical Practitioner	None	1346923711	0	0	JUGLER, LOGAN P PA-C	8/14/2023	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
312553	Non-Physician Medical Practitioner	None	1346544830	0	0	JOHNSON, MARCELLINA NP	9/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1033 S SHASTA STREET	None	WEST COVINA	CA	91791	3613	00	06000	34.05611365	-117.8981309	Los Angeles County
312566	Non-Physician Medical Practitioner	None	1346426640	0	0	JADAV, AIMEE MARIE	3/3/2008	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	CC 2315	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312792	Non-Physician Medical Practitioner	None	1467145938	0	0	JOHNSON, MARISSA NP	9/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E 28TH ST	419	LONG BEACH	CA	90806	2775	00	06000	33.80803441	-118.1847137	Los Angeles County
312843	Non-Physician Medical Practitioner	None	1720316458	0	0	JONES, MEEGAN E	7/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1906 BARCELONA ST	None	VISTA	CA	92081	5027	00	06000	33.17153728	-117.2417503	San Diego County
312854	Non-Physician Medical Practitioner	None	1871192492	0	0	JAYEOBA- SAMPAY, FOLASHADE NP	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	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	00	06000	34.09544496	-117.5747968	San Bernardino County
312887	Non-Physician Medical Practitioner	None	1205336963	0	0	JOVEL, IRINA M NP	4/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16455 MAIN ST	STE 1	HESPERIA	CA	92345	3500	00	06000	34.42186386	-117.3038021	San Bernardino County
312925	Non-Physician Medical Practitioner	None	1396416442	0	0	JOSOWITZ, JULIA N PA-C	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	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
312953	Non-Physician Medical Practitioner	None	1851610661	0	0	JARVIS, TERESA A CNM	6/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
312989	Non-Physician Medical Practitioner	None	1295754109	0	0	JACKSON, ALICE J NP	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12809 ROAD 37 3/4	None	MADERA	CA	93636	8750	00	06000	36.934758	-119.8624825	Madera County
313000	Non-Physician Medical Practitioner	None	1619146503	0	0	JACOBSON, AMY A NP	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	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
313011	Non-Physician Medical Practitioner	None	1265543730	0	0	JORGENSEN, KEVIN JERARD	5/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1217 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4642	00	06000	34.0111325	-118.1136867	Los Angeles County
313031	Non-Physician Medical Practitioner	None	1891866828	0	0	JEAN-PIERRE, GRACE	11/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10206 REGENT ST	APT 2	LOS ANGELES	CA	90034	6991	00	06000	34.02370165	-118.4038499	Los Angeles County
313057	Non-Physician Medical Practitioner	None	1245453372	0	0	JORDAN, SHAUN MICHELLE	5/15/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3633 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3510	00	06000	33.93010498	-118.2018728	Los Angeles County
313080	Non-Physician Medical Practitioner	None	1689984239	0	0	JOHNSON, KELLY L NP	5/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 W EL CAMINO REAL	#422	SUNNYVALE	CA	94087	1664	00	06000	37.37264326	-122.0516125	Santa Clara County
313110	Non-Physician Medical Practitioner	None	1710663562	0	0	JANDU, PARMINDER NP	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
313153	Non-Physician Medical Practitioner	None	1396854246	0	0	JONES, TALYNUA R	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10260 PORTO MONIZ WAY	None	ELK GROVE	CA	95757	3428	00	06000	38.384748	-121.4266725	Sacramento County
313222	Non-Physician Medical Practitioner	None	1275588717	0	0	JOSES, JENNIFER L	2/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 S MAIN ST	None	ANGELS CAMP	CA	95223	0000	00	06000	38.07977046	-120.5551132	Calaveras County
313276	Non-Physician Medical Practitioner	None	1164289872	0	0	JONES, JACQUELINE NP	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 N LA CIENEGA BLVD	SUITE 107	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
313339	Non-Physician Medical Practitioner	None	1902381155	0	0	JARDINE, LAURA E NP	3/12/2019	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
313384	Non-Physician Medical Practitioner	None	1457724239	0	0	JENSEN, CHRISTOPHER PA	5/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
313389	Non-Physician Medical Practitioner	None	1669621371	0	0	JEE, CHRISTINA	5/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	00	06000	37.74802705	-122.4207367	San Francisco County
313440	Non-Physician Medical Practitioner	None	1013562065	0	0	JONES, AMELIA C PA	9/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313446	Non-Physician Medical Practitioner	None	1194151704	0	0	JHATU, HARINDER S	9/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1316 BLAKELY LANE	None	MODESTO	CA	95356	8984	00	06000	37.69701248	-121.015044	Stanislaus County
313472	Non-Physician Medical Practitioner	None	1942736129	0	0	JIMMEYE, CYNTHIA NP	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1187 E HERNDON AVE	106	FRESNO	CA	93720	3166	00	06000	36.83640179	-119.7674647	Fresno County
313475	Non-Physician Medical Practitioner	None	1770290934	0	0	JONES, BRASHONA PA	8/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2270 E PALMDALE BLVD	STE F	PALMDALE	CA	93550	1334	00	06000	34.58009827	-118.0881861	Los Angeles County
313603	Non-Physician Medical Practitioner	None	1841602331	0	0	JORDAN, NATANE R	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	52 N PARKWOOD AVE	None	PASADENA	CA	91107	3526	00	06000	34.14705107	-118.111834	Los Angeles County
313619	Non-Physician Medical Practitioner	None	1366052805	0	0	JORDAN, DEADRA NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
313704	Non-Physician Medical Practitioner	None	1396760252	0	0	JEFFERY, JESSIE	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7301 S WESTERN AVE	None	LOS ANGELES	CA	90047	2254	00	06000	33.973479	-118.309018	Los Angeles County
313729	Non-Physician Medical Practitioner	None	1760606438	0	0	JONES-SMOTHERMAN, BETTY Y	5/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	516 CANYON VISTA	None	THOUSAND OAKS	CA	91320	0000	00	06000	34.18794792	-118.9086736	Ventura County
313751	Non-Physician Medical Practitioner	None	1114143211	0	0	JANN, SONG S PA	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	00	06000	33.52069117	-117.1653103	Riverside County
313770	Non-Physician Medical Practitioner	None	1487190633	0	0	JANG, HYOHYUN NP	8/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	00	06000	39.74473059	-121.8488381	Butte County
313788	Non-Physician Medical Practitioner	None	1164505590	0	0	JONUSAS, KARINA PA	7/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
313885	Non-Physician Medical Practitioner	None	1831956739	0	0	JAIME, KAELYNN	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
313977	Non-Physician Medical Practitioner	None	1912254798	0	0	JOHNSON, DIANA J NP	10/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21709 MARJORIE AVENUE	None	TORRANCE	CA	90503	6421	00	06000	33.83156185	-118.3605401	Los Angeles County
314016	Non-Physician Medical Practitioner	None	1134561814	0	0	J, GONTIZ D	9/30/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	00	06000	37.9839146	-121.3516231	San Joaquin County
314220	Non-Physician Medical Practitioner	None	1770988370	0	0	JWCH INSTITUTE, INC	4/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	00	06000	33.93782301	-118.1288691	Los Angeles County
314248	Non-Physician Medical Practitioner	None	1164179214	0	0	JOHNSON, RYAN PA-C	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	00	06000	33.18781249	-117.2923383	San Diego County
314464	Non-Physician Medical Practitioner	None	1912043647	0	0	JOHNSON, PATRICIA NP	11/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
314475	Non-Physician Medical Practitioner	None	1326480229	0	0	JOHNSON, KYLE B	1/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39201 SHREE RD	None	TEMECULA	CA	92591	7282	00	06000	33.5518018	-117.1199482	Riverside County
314492	Non-Physician Medical Practitioner	None	1023253648	0	0	JEAN-JACQUES, EMMANUEL PA	10/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
314505	Non-Physician Medical Practitioner	None	1689001687	0	0	JUNG, DEANNA D NP	8/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8710 E RUNNING SPRINGS D	None	ANAHEIM	CA	92808	1656	00	06000	33.85816858	-117.7239345	Orange County
314536	Non-Physician Medical Practitioner	None	1518212299	0	0	JENSEN, JENNIFER LYNN	8/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 E COOLEY DR	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.306315	San Bernardino County
314575	Non-Physician Medical Practitioner	None	1164581211	0	0	JAZWIN, ROBERT PA-C	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G ST STE C	None	MERCED	CA	95340	0978	00	06000	37.32464815	-120.4692963	Merced County
314588	Non-Physician Medical Practitioner	None	1740944909	0	0	JOUNG, SU JUNG 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	6926 BROCKTON AVE STE 8	None	RIVERSIDE	CA	92506	3804	00	06000	33.947919	-117.3967225	Riverside County
314616	Non-Physician Medical Practitioner	None	1538349477	0	0	JAUWENA, OSWALD E NP	9/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27815 SPRING MEADOW CT	None	SUN CITY	CA	92585	9704	00	06000	33.71627253	-117.172436	Riverside County
314623	Non-Physician Medical Practitioner	None	1326641267	0	0	JUDE, LAURA	8/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
314722	Non-Physician Medical Practitioner	None	1982860037	0	0	JUNG, SONJA LOUISE-URE	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	2200 OFARRELL ST FL 2	CARDIOLOGY	SAN FRANCISCO	CA	94115	3357	00	06000	37.78224789	-122.4412946	San Francisco County
314725	Non-Physician Medical Practitioner	None	1194437806	0	0	JUKKA, KENDALL 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	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
314737	Non-Physician Medical Practitioner	None	1841739950	0	0	JIMENEZ, DAEVRISSA S NP	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	124 8TH STREET	APT 1	HUNTINGTON BEACH	CA	92648	5064	00	06000	33.66015713	-118.0044851	Orange County
314804	Non-Physician Medical Practitioner	None	1265515340	0	0	JAMES, STACY H NP	1/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	84 FAIRWAYS DR	None	NAPA	CA	94558	1214	00	06000	38.35972669	-122.2642544	Napa County
314837	Non-Physician Medical Practitioner	None	1417005695	0	0	JOHNSON, LORNA M	10/1/1996	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	00	06000	33.97478347	-118.253943	Los Angeles County
314878	Non-Physician Medical Practitioner	None	1962027516	0	0	JULIO, DANNIE NP	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27720 JEFFERSON	SUITE 200	TEMECULA	CA	92590	2610	00	06000	33.51188961	-117.1586219	Riverside County
314929	Non-Physician Medical Practitioner	None	1972058584	0	0	JOHNSON, MARNE B NP	10/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 NEWCASTLE CT	None	MODESTO	CA	95355	4718	00	06000	37.65435654	-120.9318422	Stanislaus County
314995	Non-Physician Medical Practitioner	None	1780263202	0	0	JOPLIN, SONJA E PA-C	7/26/2021	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 260	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
315056	Non-Physician Medical Practitioner	None	1477753721	0	0	JIMENEZ, IMELDA M NP	2/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1844 ELMHURST CIRCLE	None	CLAREMONT	CA	91711	2958	00	06000	34.11679068	-117.7022678	Los Angeles County
315151	Non-Physician Medical Practitioner	None	1811922255	0	0	JUDSON, LEONA ELIZABETH	4/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3536 MENDOCINO AVENUE	SUITE 300	SANTA ROSA	CA	95403	0000	00	06000	38.473326	-122.725935	Sonoma County
315195	Non-Physician Medical Practitioner	None	1528071800	0	0	JORJORIAN, LUCY NANETTE	12/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	00	06000	38.596581	-121.4303535	Sacramento County
315274	Non-Physician Medical Practitioner	None	1205899929	0	0	JIN, JUNG Y	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	270 INTERNATIONAL CIR	CARDIAC CATH LAB	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
315311	Non-Physician Medical Practitioner	None	1205128857	0	0	JONES, YASMINE A NP	11/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 ALHAMBRA DRIVE	APT 118	DAVIS	CA	95618	7149	00	06000	38.558816	-121.6967675	Yolo County
315340	Non-Physician Medical Practitioner	None	1780017632	0	0	JANG, ELISHA B NP	4/22/2020	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
315384	Non-Physician Medical Practitioner	None	1437231164	0	0	JONES, TIMOTHY S 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	2525 ERRINGER RD.	None	SIMI VALLEY	CA	93065	2352	00	06000	34.280838	-118.7614975	Ventura County
315441	Non-Physician Medical Practitioner	None	1154800662	0	0	JOSHI, PAYAL NP	10/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 VISTA LA CUESTA	None	RANCHO SANTA MARG	CA	92688	3008	00	06000	33.65557882	-117.5844334	Orange County
315519	Non-Physician Medical Practitioner	None	1720155294	0	0	JURAS, JAMI L	11/5/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15278 COOPER AVE	None	SAN JOSE	CA	95124	5405	00	06000	37.24622502	-121.9383238	Santa Clara County
315527	Non-Physician Medical Practitioner	None	1811267552	0	0	JO, BAKER 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	3883 AIRWAY DR	None	SANTA ROSA	CA	95403	1670	00	06000	38.483226	-122.739705	Sonoma County
315546	Non-Physician Medical Practitioner	None	1659605327	0	0	JOLING, SHANTEL NICOLE	1/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	475 BRUCE ST	None	YREKA	CA	96097	3474	00	06000	41.71860037	-122.6467317	Siskiyou County
315554	Non-Physician Medical Practitioner	None	1225445836	0	0	JOHNSON, SHELBY R PA-C	12/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
315575	Non-Physician Medical Practitioner	None	1649337775	0	0	JOSEPH, LAURY ANN	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	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	00	06000	38.00403417	-121.8422798	Contra Costa County
315594	Non-Physician Medical Practitioner	None	1043497472	0	0	JABEEN, MOBASHSHERA	8/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1431 W 257TH ST	STE 3	HARBOR CITY	CA	90710	2753	00	06000	33.79052047	-118.3022415	Los Angeles County
315614	Non-Physician Medical Practitioner	None	1326758517	0	0	JAMESON, MELISSA S NP	3/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	00	06000	33.91745451	-117.9133065	Orange County
315637	Non-Physician Medical Practitioner	None	1225035991	0	0	JAVIER, HOPE A NP	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	10410 EAGLE CANYON RD	None	SAN DIEGO	CA	92127	7866	00	06000	33.03095766	-117.1123263	San Diego County
315710	Non-Physician Medical Practitioner	None	1134229347	0	0	JOHNSTONE, MARGARET 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	2740 GRANT ST	None	CONCORD	CA	94520	2265	00	06000	37.98580944	-122.0385574	Contra Costa County
315790	Non-Physician Medical Practitioner	None	1255716338	0	0	JONES, CRISTI W PA	12/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	00	06000	34.29981583	-118.473722	Los Angeles County
315927	Non-Physician Medical Practitioner	None	1104240399	0	0	JEUDINE, GETHO M PA	11/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5448 EVENING SKY DRIVE	None	SIMI VALLEY	CA	93063	5745	00	06000	34.29617457	-118.6856865	Ventura County
316075	Ordering, Referring, Prescribing	N/A	1003053851	0	0	JENG, AARON I MD MPH	10/10/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106414	N/A	N/A	N/A	N/A	N/A	1113 FOOTHILL BLVD	None	LA CANADA FLINTRI	CA	91011	3207	00	06000	34.20572439	-118.2029328	Los Angeles County
316099	Ordering, Referring, Prescribing	N/A	1003109901	0	0	JAMES, LORI L LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49014	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
316170	Ordering, Referring, Prescribing	N/A	1003212549	0	0	JO, DANIEL J	8/24/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64087	N/A	N/A	N/A	N/A	N/A	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	00	06000	33.844239	-116.5282075	Riverside County
316208	Ordering, Referring, Prescribing	N/A	1003256355	0	0	JAMES, KATHLEEN P LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74159	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0100	00	06000	34.54007429	-117.2744761	San Bernardino County
316285	Ordering, Referring, Prescribing	N/A	1003367418	0	0	JIN, DOROTHY R PHARMD	12/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75513	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
316324	Ordering, Referring, Prescribing	N/A	1003426289	0	0	JONES, ASIANYA LMFT	10/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141866	N/A	N/A	N/A	N/A	N/A	3840 ROSIN CT	100	SACRAMENTO	CA	95834	1639	00	06000	38.637567	-121.473306	Sacramento County
316378	Ordering, Referring, Prescribing	N/A	1003497744	0	0	JOSTES, ALEXANDRA L MD	10/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7659	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
316388	Ordering, Referring, Prescribing	N/A	1003542143	0	0	JOHNSON, SUMON NP	10/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017865	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVENUE	STE 500	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
316458	Ordering, Referring, Prescribing	N/A	1003953886	0	0	JAUREGUI, CYNTHIA J LMFT	8/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46152	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
316515	Ordering, Referring, Prescribing	N/A	1013059229	0	0	JOSEPH, ENAS LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20855	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
316583	Ordering, Referring, Prescribing	N/A	1013187194	0	0	JESPERSEN, LORI A PSYD	6/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21873	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	0000	00	06000	38.425482	-122.75262	Sonoma County
316588	Ordering, Referring, Prescribing	N/A	1013205442	0	0	JONES, ALANA N LMFT	6/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126476	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	0071	00	06000	37.8007257	-122.2064578	Alameda County
316653	Ordering, Referring, Prescribing	N/A	1013302108	0	0	JONES, RICHARD R DO	7/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19200	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
316688	Ordering, Referring, Prescribing	N/A	1013349919	0	0	JOHNSON, CASEY L NP	5/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014526	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
316694	Ordering, Referring, Prescribing	N/A	1013359355	0	0	JELINSKI, LAURA LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53646	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
316797	Ordering, Referring, Prescribing	N/A	1013537737	0	0	JONES, JACQUELYN N LMFT	5/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122665	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
316848	Ordering, Referring, Prescribing	N/A	1013789411	0	0	JHANGIANI, SRISHA A PA-C	2/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA63564	N/A	N/A	N/A	N/A	N/A	1000 E DOMINGUEZ ST	SUITE 110	CARSON	CA	90746	3600	00	06000	33.8404157	-118.2575491	Los Angeles County
316883	Ordering, Referring, Prescribing	N/A	1023100013	0	0	JAMES, LINDA MD	3/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90251	N/A	N/A	N/A	N/A	N/A	23772 NEWHALL AVE	None	NEWHALL	CA	91321	3125	00	06000	34.37160007	-118.5160227	Los Angeles County
316933	Ordering, Referring, Prescribing	N/A	1023171725	0	0	JOYCE, ELIZABETH NP	5/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	410131	N/A	N/A	N/A	N/A	N/A	810 E D ST	None	LEMOORE	CA	93245	9545	00	06000	36.30069303	-119.7694815	Kings County
316950	Ordering, Referring, Prescribing	N/A	1023225273	0	0	JOGOPULOS, MICHAEL G LCSW	12/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20938	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	MS5-120	FAIRFIELD	CA	94533	6717	00	06000	38.23532718	-122.0663968	Solano County
317016	Ordering, Referring, Prescribing	N/A	1023382819	0	0	JOHNSON, LESLEY A LMFT	4/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45829	N/A	N/A	N/A	N/A	N/A	4150 UTE DR	None	SAN DIEGO	CA	92117	5853	00	06000	32.80925642	-117.2018921	San Diego County
317044	Ordering, Referring, Prescribing	N/A	1023417912	0	0	JOHNSON, ELEASE M LMFT	3/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125027	N/A	N/A	N/A	N/A	N/A	625 34TH STREET	STE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
317114	Ordering, Referring, Prescribing	N/A	1023519253	0	0	JAUREGUI, JACQUELINE LCSW	2/18/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW128746	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
317163	Ordering, Referring, Prescribing	N/A	1023597093	0	0	JOHNSON, BETH A NP	5/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030049	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA RD	None	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
317167	Ordering, Referring, Prescribing	N/A	1023612843	0	0	JOHNSON, JILLIAN M NP	11/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015514	N/A	N/A	N/A	N/A	N/A	1101 LAS TABLAS RD	SUITE G	PASO ROBLES	CA	93465	9731	00	06000	35.55437551	-120.718593	San Luis Obispo County
317168	Ordering, Referring, Prescribing	N/A	1023609302	0	0	JUAREZ, ALONDRA LCSW	10/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118959	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
317225	Ordering, Referring, Prescribing	N/A	1023783248	0	0	JOHNSON, JENNIFER PHD	5/15/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33295	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
317229	Ordering, Referring, Prescribing	N/A	1023824034	0	0	JUAREZ HERNANDEZ, FLOR NP	5/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030010	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
317278	Ordering, Referring, Prescribing	N/A	1033228218	0	0	JONES, ROBERT W LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21647	N/A	N/A	N/A	N/A	N/A	1612 FIRST ST.	None	COACHELLA	CA	92236	1407	00	06000	33.68337881	-116.1784614	Riverside County
317286	Ordering, Referring, Prescribing	N/A	1033172754	0	0	JAVIER, JOYCE R MD FAAP	2/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80169	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD. MS#53	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
317342	Ordering, Referring, Prescribing	N/A	1033318316	0	0	JEWERT, JENNIFER J LCSW	3/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28890	N/A	N/A	N/A	N/A	N/A	1841 E MAIN ST	None	BARSTOW	CA	92311	3234	00	06000	34.8901829	-116.9978731	San Bernardino County
317363	Ordering, Referring, Prescribing	N/A	1033374533	0	0	JACOBSON, NITA M LMFT	6/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45596	N/A	N/A	N/A	N/A	N/A	3100 ACTIS STREET	None	BAKERSFIELD	CA	93309	5911	00	06000	35.3271387	-119.0521818	Kern County
317389	Ordering, Referring, Prescribing	N/A	1033423090	0	0	JONES, JENNIFER S OT	3/26/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	9360	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS 53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
317406	Ordering, Referring, Prescribing	N/A	1033441316	0	0	JONES, SETAREH S MD	1/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110010	N/A	N/A	N/A	N/A	N/A	165 S FIRST ST.	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
317508	Ordering, Referring, Prescribing	N/A	1033583349	0	0	JOO, KYUNG W	2/25/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65212	N/A	N/A	N/A	N/A	N/A	11333 PROSPECT DR	None	JACKSON	CA	95642	9311	00	06000	38.3716103	-120.8004838	Amador County
317521	Ordering, Referring, Prescribing	N/A	1033596150	0	0	JABERI, METRA LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83711	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
317525	Ordering, Referring, Prescribing	N/A	1033601760	0	0	JOY, TARIA LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	25658	N/A	N/A	N/A	N/A	N/A	200 7TH AVENUE	150	SANTA CRUZ	CA	95062	4669	00	06000	36.96438797	-121.998448	Santa Cruz County
317572	Ordering, Referring, Prescribing	N/A	1033675301	0	0	JOO, YUN HEI LCSW	8/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125550	N/A	N/A	N/A	N/A	N/A	640 S. MAIN STREET	None	LOS ANGELES	CA	90014	2004	00	06000	34.04437875	-118.2508159	Los Angeles County
317583	Ordering, Referring, Prescribing	N/A	1033691928	0	0	JOSLIN, MOLLY A LCSW	9/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125889	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
317622	Ordering, Referring, Prescribing	N/A	1033781851	0	0	JI, CHENQI L	11/16/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106499	N/A	N/A	N/A	N/A	N/A	1790 E MANNING AVE	None	REEDLEY	CA	93654	9467	00	06000	36.60411951	-119.428434	Fresno County
317680	Ordering, Referring, Prescribing	N/A	1043245418	0	0	JETT, REBECCA J PA	9/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	20526	N/A	N/A	N/A	N/A	N/A	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
317694	Ordering, Referring, Prescribing	N/A	1043334709	0	0	JO, KYONG PSYD	6/28/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32459	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
317833	Ordering, Referring, Prescribing	N/A	1043598915	0	0	JONG, CINDY PSYD	1/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22406	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
317855	Ordering, Referring, Prescribing	N/A	1043634686	0	0	JOHN, MONCY R NP	11/4/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	650527	N/A	N/A	N/A	N/A	N/A	1215 JEFFERSON AVE	None	DELANO	CA	93215	2203	00	06000	35.77250027	-119.2451029	Kern County
317907	Ordering, Referring, Prescribing	N/A	1043707326	0	0	JOHN, TANNER MD	10/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164429	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
317926	Ordering, Referring, Prescribing	N/A	1043734908	0	0	JACOBSON, AUBREY S PA	2/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54891	N/A	N/A	N/A	N/A	N/A	14372 BEACH BLVD	None	WESTMINSTER	CA	92683	4578	00	06000	33.75341465	-117.989413	Orange County
317927	Ordering, Referring, Prescribing	N/A	1043732324	0	0	JULIANO, NICOLE LMFT	1/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144422	N/A	N/A	N/A	N/A	N/A	6850 MORRO RD	None	ATASCADERO	CA	93422	4123	00	06000	35.48202343	-120.6660628	San Luis Obispo County
317977	Ordering, Referring, Prescribing	N/A	1043810617	0	0	JAIN, ASHNA A	12/8/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105750	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
317982	Ordering, Referring, Prescribing	N/A	1043830763	0	0	JUACHE, GABRIELA PA-C	7/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59446	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
318001	Ordering, Referring, Prescribing	N/A	1043859978	0	0	JAMA, FARAH H NP	9/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025394	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
318006	Ordering, Referring, Prescribing	N/A	1043863160	0	0	JENMI, ZAINOB NP	4/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95233839	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	475	LOS ANGELES	CA	90017	0449	00	06000	34.04532806	-118.258462	Los Angeles County
318102	Ordering, Referring, Prescribing	N/A	1053402958	0	0	JACKSON, XOCHITL MD	11/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90947	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
318118	Ordering, Referring, Prescribing	N/A	1053423202	0	0	JOHL, HARPREET MD	7/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84794	N/A	N/A	N/A	N/A	N/A	3710 STATE HIGHWAY 45	None	COLUSA	CA	95932	0000	00	06000	39.25060345	-122.0314303	Colusa County
318201	Ordering, Referring, Prescribing	N/A	1053560961	0	0	JACOBY, SHERRIE L NP	8/26/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	482381	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
318285	Ordering, Referring, Prescribing	N/A	1053708610	0	0	JIMENEZ, DALILA LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107633	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
318291	Ordering, Referring, Prescribing	N/A	1053714360	0	0	JALOMO, JUANITA NP	9/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010669	N/A	N/A	N/A	N/A	N/A	2133 WINTERHAVEN DR	None	WINTERHAVEN	CA	92283	9609	00	06000	32.73859108	-114.6357818	Imperial County
318300	Ordering, Referring, Prescribing	N/A	1053726695	0	0	JEN, NA DO	5/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16741	N/A	N/A	N/A	N/A	N/A	1215 WABASH AVENUE	None	REDLANDS	CA	92374	4963	00	06000	34.068627	-117.138919	San Bernardino County
318367	Ordering, Referring, Prescribing	N/A	1053795823	0	0	JOO, ESTHER MD	7/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143931	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
318376	Ordering, Referring, Prescribing	N/A	1053816157	0	0	JIMENEZ, AARON-ROSS G MD MPH	7/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174214	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
318434	Ordering, Referring, Prescribing	N/A	1053909010	0	0	JULIUS, NATALIE PHARMD	10/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83828	N/A	N/A	N/A	N/A	N/A	22108 COPPER HILL DR	None	SANTA CLARITA	CA	91350	3963	00	06000	34.45923433	-118.5224337	Los Angeles County
318452	Ordering, Referring, Prescribing	N/A	1053975508	0	0	JARAMILLO, ERICKA G MD	1/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177992	N/A	N/A	N/A	N/A	N/A	10561 MERRITT ST	None	CASTROVILLE	CA	95012	3310	00	06000	36.76699229	-121.7597014	Monterey County
318488	Ordering, Referring, Prescribing	N/A	1063071793	0	0	JAGTAP, NEELAM P	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60712	N/A	N/A	N/A	N/A	N/A	15840 HESPERIAN BLVD	None	SAN LORENZO	CA	94580	1538	00	06000	37.68188904	-122.1282585	Alameda County
318522	Ordering, Referring, Prescribing	N/A	1063225084	0	0	JONES, JULIANA D RDH	2/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	21336	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
318586	Ordering, Referring, Prescribing	N/A	1063547230	0	0	JONES, KRISTEN J LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52024	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
318596	Ordering, Referring, Prescribing	N/A	1063555100	0	0	JANG, JANICE E PHARMD	6/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51308	N/A	N/A	N/A	N/A	N/A	5161 BEACH BLVD	C	BUENA PARK	CA	90621	1171	00	06000	33.88524753	-117.9951446	Orange County
318597	Ordering, Referring, Prescribing	N/A	1063555076	0	0	JAMES, SHAAN LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81814	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
318629	Ordering, Referring, Prescribing	N/A	1063612745	0	0	JONES, SHATAE M LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76650	N/A	N/A	N/A	N/A	N/A	3480 BUSKIRK	210	PLEASANT HILL	CA	94523	0000	00	06000	37.94004473	-122.0590134	Contra Costa County
318638	Ordering, Referring, Prescribing	N/A	1063643930	0	0	JOHNSON, JENNIFER LCSW	4/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23316	N/A	N/A	N/A	N/A	N/A	7807 N LANDER	None	HILMAR	CA	95324	9398	00	06000	37.40139596	-120.8502103	Merced County
318681	Ordering, Referring, Prescribing	N/A	1063724060	0	0	JAIN, BHARAT	5/14/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC31705	N/A	N/A	N/A	N/A	N/A	1360 E ANAHEIM ST	None	LONG BEACH	CA	90813	5514	00	06000	33.78258054	-118.1744415	Los Angeles County
318683	Ordering, Referring, Prescribing	N/A	1063715191	0	0	JUKKA, VICTORIA A	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	39636	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
318725	Ordering, Referring, Prescribing	N/A	1063790855	0	0	JOSHI, TRIPTI T	10/31/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100380	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
318774	Ordering, Referring, Prescribing	N/A	1063836120	0	0	JOSEPH, SHARY NP	12/26/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000247	N/A	N/A	N/A	N/A	N/A	303 N EAST STREET	None	ANAHEIM	CA	92805	3341	00	06000	33.84042094	-117.9034309	Orange County
318972	Ordering, Referring, Prescribing	N/A	1073163135	0	0	JOHNS, KARESSA LCSW	9/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125905	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
318979	Ordering, Referring, Prescribing	N/A	1073182077	0	0	JOHNSON, EMILY PHD	11/20/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34698	N/A	N/A	N/A	N/A	N/A	3671 BUSINESS DR	None	SACRAMENTO	CA	95820	2165	00	06000	38.54133	-121.41891	Sacramento County
318996	Ordering, Referring, Prescribing	N/A	1073259222	0	0	JAY, BEAULAH	8/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020691	N/A	N/A	N/A	N/A	N/A	722 E CHAPEL ST	None	SANTA MARIA	CA	93454	5424	00	06000	34.9542574	-120.4253971	Santa Barbara County
319117	Ordering, Referring, Prescribing	N/A	1073812426	0	0	JUAREZ, VERONICA LCSW	11/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68437	N/A	N/A	N/A	N/A	N/A	7515 VAN NUYS BLVD	#461	VAN NUYS	CA	91405	1949	00	06000	34.207344	-118.4487995	Los Angeles County
319122	Ordering, Referring, Prescribing	N/A	1073816468	0	0	JACOBY-SHELDON, JENNIFER A LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82954	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
319135	Ordering, Referring, Prescribing	N/A	1073846465	0	0	JARAMILLO, OFELIA LCSW	6/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76824	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	0008	00	06000	34.06300636	-118.2054784	Los Angeles County
319166	Ordering, Referring, Prescribing	N/A	1073901138	0	0	JONAN, ANNA L NP	7/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009446	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	STE 201	CHULA VISTA	CA	91911	2975	00	06000	32.60364599	-117.0786521	San Diego County
319181	Ordering, Referring, Prescribing	N/A	1073924569	0	0	JONES, RACHEL CCC-SLP	12/21/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	36532	N/A	N/A	N/A	N/A	N/A	76280 HIGH SCHOOL ST.	None	COVELO	CA	95428	0001	00	06000	39.79238903	-123.2558233	Mendocino County
319273	Ordering, Referring, Prescribing	N/A	1083053342	0	0	JAGUR, PARMINDER P	8/7/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5214	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
319302	Ordering, Referring, Prescribing	N/A	1083097901	0	0	JACKSON, JERRY L LMFT	10/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135284	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
319315	Ordering, Referring, Prescribing	N/A	1083120067	0	0	JENNINGS, SARA CNP	1/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007401	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	FC 62	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
319345	Ordering, Referring, Prescribing	N/A	1083166094	0	0	JAFFERY, SYEDA LCSW	9/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108587	N/A	N/A	N/A	N/A	N/A	400 CONCAR DR	None	SAN MATEO	CA	94402	2681	00	06000	37.55338259	-122.3076528	San Mateo County
319420	Ordering, Referring, Prescribing	N/A	1083320097	0	0	JACKSON, KATHERINA LCSW	3/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19645	N/A	N/A	N/A	N/A	N/A	3600 POWER INN RD	None	SACRAMENTO	CA	95826	3826	00	06000	38.541726	-121.4096355	Sacramento County
319472	Ordering, Referring, Prescribing	N/A	1083697148	0	0	JOE, JEFFREY M	8/27/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D29831	N/A	N/A	N/A	N/A	N/A	1121 HAMMOND ST	None	MODESTO	CA	95351	3509	00	06000	37.614366	-121.0186465	Stanislaus County
319489	Ordering, Referring, Prescribing	N/A	1083738744	0	0	JONES, CAMMIE W	11/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15445	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
319590	Ordering, Referring, Prescribing	N/A	1083941207	0	0	JONES, CLEA LMFT	11/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102770	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
319623	Ordering, Referring, Prescribing	N/A	1083989065	0	0	JIMENEZ, JANETTE LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77643	N/A	N/A	N/A	N/A	N/A	1200 N. STATE ST	STE. 1016	LOS ANGELES	CA	90033	1001	00	06000	34.05855992	-118.209755	Los Angeles County
319707	Ordering, Referring, Prescribing	N/A	1093144008	0	0	JAWED, ISMAH PA	10/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51255	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
319796	Ordering, Referring, Prescribing	N/A	1093267163	0	0	JOHNSON, VERONICA A LPCC	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10091	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	201	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
319856	Ordering, Referring, Prescribing	N/A	1093417602	0	0	JACQUES, MADELEINE MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197228	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
319942	Ordering, Referring, Prescribing	N/A	1093867616	0	0	JOHNSON, ANGEL C LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48373	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
319951	Ordering, Referring, Prescribing	N/A	1093878258	0	0	JAVDAN, RON MD	8/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50454	N/A	N/A	N/A	N/A	N/A	3631 CRENSHAW BLVD	STE 109	LOS ANGELES	CA	90016	4869	00	06000	34.023177	-118.3351475	Los Angeles County
320080	Ordering, Referring, Prescribing	N/A	1104134386	0	0	JUDELMAN, KEITH M NP	9/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012894	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
320172	Ordering, Referring, Prescribing	N/A	1104280551	0	0	JIN, SHA MD	4/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	A150516	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
320178	Ordering, Referring, Prescribing	N/A	1104297803	0	0	JOHN, RANI S	3/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002474	N/A	N/A	N/A	N/A	N/A	13302 BRASS RING LN	None	EASTVALE	CA	92880	3490	00	06000	33.95768843	-117.5734733	Riverside County
320202	Ordering, Referring, Prescribing	N/A	1104334473	0	0	JAHANPANAH, PARVIN LMFT	3/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101777	N/A	N/A	N/A	N/A	N/A	16661 VENTURA BLVD.	SUITE 400J	ENCINO	CA	91436	1914	00	06000	34.15820737	-118.496492	Los Angeles County
320353	Ordering, Referring, Prescribing	N/A	1104950807	0	0	JUROS, JAKUB MD	11/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100526	N/A	N/A	N/A	N/A	N/A	10515 BALBOA BLVD	376	GRANADA HILLS	CA	91344	6343	00	06000	34.261497	-118.502318	Los Angeles County
320407	Ordering, Referring, Prescribing	N/A	1114042918	0	0	JASSO TAPIA, GABRIELA LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29206	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
320428	Ordering, Referring, Prescribing	N/A	1114073392	0	0	JONES, WILLIAM L LMFT	6/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39857	N/A	N/A	N/A	N/A	N/A	2387 LISA LANE	None	PLEASANT HILL	CA	94523	3949	00	06000	37.94521553	-122.051844	Contra Costa County
320442	Ordering, Referring, Prescribing	N/A	1114097144	0	0	JENKINS, JOHN G	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D25810	N/A	N/A	N/A	N/A	N/A	5335 LAKESHORE BLVD	None	LAKEPORT	CA	95453	6123	00	06000	39.1058965	-122.9032986	Lake County
320454	Ordering, Referring, Prescribing	N/A	1114126810	0	0	JOHNSON, LISA M PHD	5/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21584	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
320476	Ordering, Referring, Prescribing	N/A	1114158664	0	0	JACKSON, ALEA N LMFT	9/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84343	N/A	N/A	N/A	N/A	N/A	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	00	06000	34.1268333	-117.2705634	San Bernardino County
320532	Ordering, Referring, Prescribing	N/A	1114282514	0	0	JONES, SIMEON D LMFT	12/31/2015	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48389	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY STREET	None	RED BLUFF	CA	96080	4505	00	06000	40.157883	-122.2250685	Tehama County
320632	Ordering, Referring, Prescribing	N/A	1114441821	0	0	JACOBS, ERIN N LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97914	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
320682	Ordering, Referring, Prescribing	N/A	1114540598	0	0	JEFFERSON, KENNYANNA LCSW	12/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127688	N/A	N/A	N/A	N/A	N/A	17053 FOOTHILL BLVD	None	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
320688	Ordering, Referring, Prescribing	N/A	1114554433	0	0	JOHNSON, ISAAC N MD	12/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	5181	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
320690	Ordering, Referring, Prescribing	N/A	1114557642	0	0	JIN, YING	1/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81821	N/A	N/A	N/A	N/A	N/A	1235 STRATFORD AVE	None	DIXON	CA	95620	2024	00	06000	38.45801447	-121.838922	Solano County
320777	Ordering, Referring, Prescribing	N/A	1124025218	0	0	JUDD, MARC W MD	5/1/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66629	N/A	N/A	N/A	N/A	N/A	301 SCIECE DR	STE 150	MOORPARK	CA	93021	2097	00	06000	34.27992368	-118.8694411	Ventura County
320819	Ordering, Referring, Prescribing	N/A	1124150826	0	0	JACKSON, DARLENE S LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42933	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
320855	Ordering, Referring, Prescribing	N/A	1124201389	0	0	JOURNEAU-COLLINS, THERESA LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80570	N/A	N/A	N/A	N/A	N/A	2990 INLAND EMPIRE BLVD	101	ONTARIO	CA	91764	4899	00	06000	34.069824	-117.5873175	San Bernardino County
320969	Ordering, Referring, Prescribing	N/A	1124415286	0	0	JOSON, MYLINH	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55890	N/A	N/A	N/A	N/A	N/A	4900 PANAMA LN	None	BAKERSFIELD	CA	93313	3479	00	06000	35.297802	-119.058516	Kern County
320993	Ordering, Referring, Prescribing	N/A	1124460597	0	0	JOO, JENNIFER	5/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67872	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
321017	Ordering, Referring, Prescribing	N/A	1124481080	0	0	JUAREZ, VICTORIA C PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65140	N/A	N/A	N/A	N/A	N/A	7095 MARKET PLACE DR	None	GOLETA	CA	93117	5905	00	06000	34.42799696	-119.873532	Santa Barbara County
321030	Ordering, Referring, Prescribing	N/A	1124505870	0	0	JARAMILLO, NATALIA PHD	9/4/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35305	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD.	SUITE 300	LOS ANGELES	CA	90010	1001	00	06000	34.06176363	-118.2932622	Los Angeles County
321143	Ordering, Referring, Prescribing	N/A	1124741251	0	0	JIMENEZ, MARTHA C LCSW	8/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110033	N/A	N/A	N/A	N/A	N/A	44261 LITTLE LAKE ROAD	226	MENDOCINO	CA	95460	1154	00	06000	39.31237687	-123.7849384	Mendocino County
321191	Ordering, Referring, Prescribing	N/A	1134183114	0	0	JIBRIL, DEANAH DO	11/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17489	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
321206	Ordering, Referring, Prescribing	N/A	1134244254	0	0	JOHNSON, LYNN C LMFT	5/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125433	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	STE. 200	SAN BERNARDINO	CA	92408	2847	00	06000	34.07137738	-117.2702805	San Bernardino County
321234	Ordering, Referring, Prescribing	N/A	1134282262	0	0	JANES, CYNTHIA A MD	11/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G153074	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
321271	Ordering, Referring, Prescribing	N/A	1134359409	0	0	JIMENEZ, SOFIA PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61072	N/A	N/A	N/A	N/A	N/A	46900 MONROE ST	BLDG E	INDIO	CA	92201	4827	00	06000	33.707718	-116.233843	Riverside County
321310	Ordering, Referring, Prescribing	N/A	1134423098	0	0	JONES, MICHELLE PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63409	N/A	N/A	N/A	N/A	N/A	298 KING ST	None	SAN FRANCISCO	CA	94107	1702	00	06000	37.77690653	-122.3936048	San Francisco County
321313	Ordering, Referring, Prescribing	N/A	1134459852	0	0	JAMWAL, PRIYANSHA S	4/4/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00112329	N/A	N/A	N/A	N/A	N/A	2170 EAST BIDWELL ST	STE 100	FOLSOM	CA	95030	6466	00	06000	38.667321	-121.1435865	Sacramento County
321319	Ordering, Referring, Prescribing	N/A	1134478159	0	0	JAHROMIFAR, SHUKA PSYD	2/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29813	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	SUITE 200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
321330	Ordering, Referring, Prescribing	N/A	1134492069	0	0	JACKSON, STEVEN E LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52239	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
321410	Ordering, Referring, Prescribing	N/A	1134612500	0	0	JOHNSTON, JILL M NP	4/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009231	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
321430	Ordering, Referring, Prescribing	N/A	1134636962	0	0	JUPITER, RAQUEL S NP	7/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95007958	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
321450	Ordering, Referring, Prescribing	N/A	1134672207	0	0	JUNG, ANDREW H PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73826	N/A	N/A	N/A	N/A	N/A	21800 VICTORY BLVD	None	WOODLAND HILLS	CA	91367	2227	00	06000	34.18735254	-118.603418	Los Angeles County
321511	Ordering, Referring, Prescribing	N/A	1134826274	0	0	JIMENEZ, ELSIE NP	5/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030193	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6101	00	06000	40.43814074	-120.6259249	Lassen County
321526	Ordering, Referring, Prescribing	N/A	1134894330	0	0	JAMSHED, SAHA LCSW	7/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103812	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
321530	Ordering, Referring, Prescribing	N/A	1134979743	0	0	JAVAID, REESHA NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029483	N/A	N/A	N/A	N/A	N/A	23772 NEWHALL AVE	None	NEWHALL	CA	91321	3125	00	06000	34.37160007	-118.5160227	Los Angeles County
321548	Ordering, Referring, Prescribing	N/A	1144223793	0	0	JENSEN, STEVE DPM	4/24/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E2833	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
321571	Ordering, Referring, Prescribing	N/A	1144325473	0	0	JOHNSON, KARLON H MD	1/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G70613	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA BLVD	101	HARBOR CITY	CA	90710	2067	00	06000	33.79785936	-118.3016552	Los Angeles County
321608	Ordering, Referring, Prescribing	N/A	1144394149	0	0	JUNG, JAMES H MD	11/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51489	N/A	N/A	N/A	N/A	N/A	2311 W.EL SEGUNDO	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
321627	Ordering, Referring, Prescribing	N/A	1144436205	0	0	JARQUIN, MARIA A LCSW	6/6/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71390	N/A	N/A	N/A	N/A	N/A	4700 INGLEWOOD BLVD	101	CULVER CITY	CA	90230	5896	00	06000	33.99315523	-118.4151866	Los Angeles County
321648	Ordering, Referring, Prescribing	N/A	1144497900	0	0	JOHNSON, JULIET L LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50541	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD.	FIRST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
321649	Ordering, Referring, Prescribing	N/A	1144486598	0	0	JORDAN, JOSEPH D	8/2/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D55968	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
321713	Ordering, Referring, Prescribing	N/A	1144611948	0	0	JACKSON, YVONNE LMFT	11/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93289	N/A	N/A	N/A	N/A	N/A	9567 ARROW RTE	SUITE M	RANCHO CUCAMONGA	CA	91730	4550	00	06000	34.09927854	-117.5968935	San Bernardino County
321787	Ordering, Referring, Prescribing	N/A	1144706649	0	0	JENSEN, CHRISTOPHER E LMFT	4/6/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105807	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE	None	SANTA CLARITA	CA	91350	2948	00	06000	34.41078438	-118.510775	Los Angeles County
321880	Ordering, Referring, Prescribing	N/A	1144838343	0	0	JIMENEZ-LEZAMA, CINDY LMFT	10/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150979	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
321892	Ordering, Referring, Prescribing	N/A	1144852369	0	0	JUAREZ, MARLEEN OT	3/10/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	20083	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
321927	Ordering, Referring, Prescribing	N/A	1144955493	0	0	JUAREZ, ARIEL DMD	1/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108700	N/A	N/A	N/A	N/A	N/A	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	00	06000	34.221609	-118.5360405	Los Angeles County
321982	Ordering, Referring, Prescribing	N/A	1154308146	0	0	JASO, JOHN G	3/13/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D31480	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
322058	Ordering, Referring, Prescribing	N/A	1154512036	0	0	JOHNSON, JEVON J MD	3/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101110	N/A	N/A	N/A	N/A	N/A	7273 14TH AVE	120-B	SACRAMENTO	CA	95820	3500	00	06000	38.540097	-121.419063	Sacramento County
322072	Ordering, Referring, Prescribing	N/A	1154538981	0	0	JACKSON, JILL M	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48173	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
322213	Ordering, Referring, Prescribing	N/A	1154787786	0	0	JUNEJA, NEERAJ CNP	3/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95003508	N/A	N/A	N/A	N/A	N/A	1945 N FINE AVE	STE 100	FRESNO	CA	93727	1528	00	06000	36.76832721	-119.7290143	Fresno County
322244	Ordering, Referring, Prescribing	N/A	1154833960	0	0	JOHNSON, AMANDA J MSW LCSW	5/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101426	N/A	N/A	N/A	N/A	N/A	260 COHASSET ROAD	120	CHICO	CA	95928	0400	00	06000	39.754035	-121.851117	Butte County
322263	Ordering, Referring, Prescribing	N/A	1154858850	0	0	JIMENEZ, SAMANTHA S MD	6/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173020	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
322344	Ordering, Referring, Prescribing	N/A	1164029310	0	0	JOSHI, AVANI K PHARMD	11/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83469	N/A	N/A	N/A	N/A	N/A	727 N VINE ST	None	LOS ANGELES	CA	90038	3717	00	06000	34.08422698	-118.3266837	Los Angeles County
322384	Ordering, Referring, Prescribing	N/A	1164089371	0	0	JURI, NICOLA J	5/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56808	N/A	N/A	N/A	N/A	N/A	1119 PACIFIC AVE.	STE. 200	SANTA CRUZ	CA	95060	4464	00	06000	36.9722444	-122.0256836	Santa Cruz County
322394	Ordering, Referring, Prescribing	N/A	1164129888	0	0	JONES, CHELSEA NP	12/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023596	N/A	N/A	N/A	N/A	N/A	905 N LA BREA AVE	None	INGLEWOOD	CA	90302	2207	00	06000	33.9749861	-118.3577191	Los Angeles County
322402	Ordering, Referring, Prescribing	N/A	1164157004	0	0	JURADO, JENNYFER K	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83556	N/A	N/A	N/A	N/A	N/A	5236 SANTA MONICA BLVD	None	LOS ANGELES	CA	90029	1210	00	06000	34.09077051	-118.3046976	Los Angeles County
322434	Ordering, Referring, Prescribing	N/A	1164460549	0	0	JOHNSON, YEH N PA	11/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	22116	N/A	N/A	N/A	N/A	N/A	4150 PATTERSON ROAD	None	RIVERBANK	CA	95367	9536	00	06000	37.73262081	-120.9200969	Stanislaus County
322490	Ordering, Referring, Prescribing	N/A	1164578795	0	0	JACOBSON, JANET C MD	5/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126260	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
322508	Ordering, Referring, Prescribing	N/A	1164618997	0	0	JURADO, XAVIER O PSYD	3/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29160	N/A	N/A	N/A	N/A	N/A	2180 MILVIA ST	None	BERKELEY	CA	94704	1122	00	06000	37.86948606	-122.2705246	Alameda County
322512	Ordering, Referring, Prescribing	N/A	1164628723	0	0	JUAREZ, MARIA R LCSW	9/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24532	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
322517	Ordering, Referring, Prescribing	N/A	1164652806	0	0	JOHNSON, JENNIFER B LMFT	8/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111437	N/A	N/A	N/A	N/A	N/A	28765 SINGLE OAK DR	100	TEMECULA	CA	92590	3661	00	06000	33.49888048	-117.1608165	Riverside County
322639	Ordering, Referring, Prescribing	N/A	1164857801	0	0	JIMENEZ, MARISOL LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83726	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD.	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
322779	Ordering, Referring, Prescribing	N/A	1174106447	0	0	JAVIER, REGINA DMD	4/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108695	N/A	N/A	N/A	N/A	N/A	4050 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.5582775	-117.046881	San Diego County
322790	Ordering, Referring, Prescribing	N/A	1174116495	0	0	JOHNSON, BRITTANY M LPCC	4/24/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC16364	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
322936	Ordering, Referring, Prescribing	N/A	1174704480	0	0	JOHNSON, BELINDA M LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36068	N/A	N/A	N/A	N/A	N/A	21561 FLAMENCO	None	MISSION VIEJO	CA	92692	1014	00	06000	33.64939601	-117.6344447	Orange County
323146	Ordering, Referring, Prescribing	N/A	1184025744	0	0	JAQUES, LILIANA	11/2/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54965	N/A	N/A	N/A	N/A	N/A	400 EAST ROMIE LANE	None	SALINAS	CA	93901	4017	00	06000	36.66043696	-121.6483124	Monterey County
323151	Ordering, Referring, Prescribing	N/A	1184026882	0	0	JAMMU, SEERAT K LCSW	12/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89974	N/A	N/A	N/A	N/A	N/A	1328 2ND ST.	None	SANTA MONICA	CA	90401	1122	00	06000	34.01557114	-118.497924	Los Angeles County
323181	Ordering, Referring, Prescribing	N/A	1184063042	0	0	JUAREZ, TONALLI LPCC	10/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8684	N/A	N/A	N/A	N/A	N/A	6401 LINDA VISTA ROAD	None	SAN DIEGO	CA	92111	7319	00	06000	32.769081	-117.1799145	San Diego County
323222	Ordering, Referring, Prescribing	N/A	1184112179	0	0	JONES, TA TANISHA PSYD	5/19/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30448	N/A	N/A	N/A	N/A	N/A	21250 SPRINGS RD	201	MORENO VALLEY	CA	92557	8712	00	06000	33.94660149	-117.29169	Riverside County
323245	Ordering, Referring, Prescribing	N/A	1184155186	0	0	JUERGENS, NATHAN W MD	8/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157601	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
323263	Ordering, Referring, Prescribing	N/A	1184170490	0	0	JANG, ALVIN LCSW	5/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101666	N/A	N/A	N/A	N/A	N/A	150 WEST 7TH ST.	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
323301	Ordering, Referring, Prescribing	N/A	1184264517	0	0	JOSIAH, MICHAEL NP	2/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004372	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
323332	Ordering, Referring, Prescribing	N/A	1184340333	0	0	JANG, ANNA H NP	8/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022193	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3935	00	06000	33.78298855	-117.9927453	Orange County
323394	Ordering, Referring, Prescribing	N/A	1184717894	0	0	JACOBSON, ILYANA LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24487	N/A	N/A	N/A	N/A	N/A	525 CABRILLO PARK DR	None	SANTA ANA	CA	92701	5017	00	06000	33.75047365	-117.8404984	Orange County
323426	Ordering, Referring, Prescribing	N/A	1184769101	0	0	JONES, PHILLIP A LCSW	5/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108732	N/A	N/A	N/A	N/A	N/A	305 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.44404517	-119.7795009	Santa Barbara County
323554	Ordering, Referring, Prescribing	N/A	1184996688	0	0	JOVANELLY GODFREY, DANIELLE G LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81552	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
323641	Ordering, Referring, Prescribing	N/A	1194172858	0	0	JASPER-BELL, LYDIA LMFT	6/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147701	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE	260	PLEASANT HILL	CA	94523	4344	00	06000	37.93963113	-122.0591644	Contra Costa County
323707	Ordering, Referring, Prescribing	N/A	1194268029	0	0	JARRETT, JESSICA J LCSW	6/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93394	N/A	N/A	N/A	N/A	N/A	1611 BUNKER HILL WAY	STE. 120	SALINAS	CA	93906	6004	00	06000	36.69971964	-121.6172769	Monterey County
323723	Ordering, Referring, Prescribing	N/A	1194290429	0	0	JONG, JENNIFER B PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79696	N/A	N/A	N/A	N/A	N/A	4801 CENTRAL AVE	None	RICHMOND	CA	94804	5801	00	06000	37.89726914	-122.3212101	Contra Costa County
323726	Ordering, Referring, Prescribing	N/A	1194303966	0	0	JOHNSON, VICTORIA DO	7/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23126	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
323730	Ordering, Referring, Prescribing	N/A	1194309724	0	0	JOHNSON, JACOB P MD	3/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184926	N/A	N/A	N/A	N/A	N/A	225 37TH AVE	None	SAN MATEO	CA	94403	4324	00	06000	37.53211966	-122.2998871	San Mateo County
323772	Ordering, Referring, Prescribing	N/A	1194448969	0	0	JALALIAN, NAZANIN NP	8/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022603	N/A	N/A	N/A	N/A	N/A	7153 HELMSDALE CIR	None	LOS ANGELES	CA	91307	1342	00	06000	34.20030817	-118.6426473	Los Angeles County
323843	Ordering, Referring, Prescribing	N/A	1194861898	0	0	JOHNSON, JARVIS W LMFT	4/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC27269	N/A	N/A	N/A	N/A	N/A	38800 SKY CANYON DR. STE	None	MURRIETA	CA	92563	2540	00	06000	33.55625282	-117.1375585	Riverside County
323864	Ordering, Referring, Prescribing	N/A	1194882860	0	0	JOHNSON-QUIJADA, SANA MD	11/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70270	N/A	N/A	N/A	N/A	N/A	32605 YNEZ RD	220	TEMECULA	CA	92591	2600	00	06000	33.51083499	-117.151119	Riverside County
323905	Ordering, Referring, Prescribing	N/A	1194976225	0	0	JACKSON, TIENNA S LCSW	3/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89122	N/A	N/A	N/A	N/A	N/A	7828 BROADWAY	None	LEMON GROVE	CA	91945	1801	00	06000	32.7428403	-117.0298029	San Diego County
324128	Ordering, Referring, Prescribing	N/A	1205377306	0	0	JONES, JORDAN D PA-C	10/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55556	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
324190	Ordering, Referring, Prescribing	N/A	1205547577	0	0	JENKINS, JENNIFER N LMFT	12/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151707	N/A	N/A	N/A	N/A	N/A	8616 LA TIJERA BLVD	SUITE 200	LOS ANGELES	CA	90045	3944	00	06000	33.95943215	-118.3918599	Los Angeles County
324196	Ordering, Referring, Prescribing	N/A	1205568664	0	0	JACOBS, HEATHER CCC-SLP	11/17/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	18490	N/A	N/A	N/A	N/A	N/A	6 NELSON ST	None	WINCHESTER	MA	01890	2124	00	06000	42.455871	-71.1316665	Middlesex County
324200	Ordering, Referring, Prescribing	N/A	1205594181	0	0	JARIWALLA, NISHA R PA-C	11/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60440	N/A	N/A	N/A	N/A	N/A	429 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1948	00	06000	37.293363	-121.9584655	Santa Clara County
324255	Ordering, Referring, Prescribing	N/A	1205937299	0	0	JANNETT, ANDREW F PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44469	N/A	N/A	N/A	N/A	N/A	28200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	00	06000	33.895494	-117.1936536	Riverside County
324296	Ordering, Referring, Prescribing	N/A	1215018502	0	0	JENKINS, GREGORY D	11/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40935	N/A	N/A	N/A	N/A	N/A	27225 CAMP PLENTY RD	SUITE 4	CANYON COUNTRY	CA	91351	2654	00	06000	34.41648627	-118.4759126	Los Angeles County
324310	Ordering, Referring, Prescribing	N/A	1215049374	0	0	JOSHI, CHANDRASHEKHAR R MD	4/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A25562	N/A	N/A	N/A	N/A	N/A	1350 E LOS ANGELES AVE	100	SIMI VALLEY	CA	93605	2806	00	06000	34.27163453	-118.7729325	Ventura County
324322	Ordering, Referring, Prescribing	N/A	1215075817	0	0	JESALVA, EDMUNDO S MD	11/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G58063	N/A	N/A	N/A	N/A	N/A	7101 BAIRD AVE.	None	RESEDA	CA	91335	4150	00	06000	34.1995012	-118.5373824	Los Angeles County
324502	Ordering, Referring, Prescribing	N/A	1215384011	0	0	JIMENEZ, ANDREA LMFT	4/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132467	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
324593	Ordering, Referring, Prescribing	N/A	1215544804	0	0	JOHNS, JARMAINE K CNP	4/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015410	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
324610	Ordering, Referring, Prescribing	N/A	1215582671	0	0	JACINTHA, AVERYLIA LMFT	5/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147146	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
324675	Ordering, Referring, Prescribing	N/A	1225037369	0	0	JAMES, KIRK A DC	11/27/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC22722	N/A	N/A	N/A	N/A	N/A	705 EAST ST	None	CORNING	CA	96021	2252	00	06000	39.92879035	-122.1757125	Tehama County
324702	Ordering, Referring, Prescribing	N/A	1225123888	0	0	JOHNSON, MARY JAYNE CNP	8/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026427	N/A	N/A	N/A	N/A	N/A	500 W HOSPITAL RD	SUITE #C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
324716	Ordering, Referring, Prescribing	N/A	1225157571	0	0	JUAREZ, CYNTHIA E LCSW	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28795	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
324807	Ordering, Referring, Prescribing	N/A	1225324379	0	0	JENKS, CONNELLY A LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69018	N/A	N/A	N/A	N/A	N/A	3210 LONG BEACH BLVD	None	LONG BEACH	CA	90807	0000	00	06000	33.815637	-118.1892215	Los Angeles County
324936	Ordering, Referring, Prescribing	N/A	1225532526	0	0	JACOBS, TOMILAYO MD	1/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173922	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
324980	Ordering, Referring, Prescribing	N/A	1225589393	0	0	JEFFERIES, JOHANNA LCSW	10/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108766	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
325067	Ordering, Referring, Prescribing	N/A	1235185653	0	0	JACKSON, CYNTHIA L PHD	12/7/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14155	N/A	N/A	N/A	N/A	N/A	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	00	06000	34.15365596	-118.1370318	Los Angeles County
325110	Ordering, Referring, Prescribing	N/A	1235291477	0	0	JOHANSSON, CHRISTINE LCSW	12/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	13979	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
325119	Ordering, Referring, Prescribing	N/A	1235317751	0	0	JIMENEZ, ARSENIO I MD	7/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60784	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	STE 105	LANCASTER	CA	93535	4577	00	06000	34.67013731	-118.1222748	Los Angeles County
325183	Ordering, Referring, Prescribing	N/A	1235421587	0	0	JUDEH, CHRISTINA C LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82024	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
325252	Ordering, Referring, Prescribing	N/A	1235535675	0	0	JUNG, SEUNGHUN DC	12/14/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	32200	N/A	N/A	N/A	N/A	N/A	106 E MAIN ST	None	FOWLER	CA	93625	2433	00	06000	36.62899034	-119.6785493	Fresno County
325358	Ordering, Referring, Prescribing	N/A	1235708777	0	0	JACKSON, SYDNEY PA-C	5/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62744	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
325601	Ordering, Referring, Prescribing	N/A	1245570266	0	0	JENKINS, MARIDEZ B	1/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22738	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
325816	Ordering, Referring, Prescribing	N/A	1245895861	0	0	JONES, JENNIFER	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109050	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
325835	Ordering, Referring, Prescribing	N/A	1245971027	0	0	JIMENEZ, ZO AMARO N PSYD	4/4/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33253	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
325838	Ordering, Referring, Prescribing	N/A	1245979095	0	0	JENNINGS, MARISSA PA	10/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62675	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
325904	Ordering, Referring, Prescribing	N/A	1255404331	0	0	JARAMILLO, GINA M PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49618	N/A	N/A	N/A	N/A	N/A	1660 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.745558	-121.247116	Placer County
325954	Ordering, Referring, Prescribing	N/A	1255504957	0	0	JONES, STEPHANIE J LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27377	N/A	N/A	N/A	N/A	N/A	1600 BAILEY AVENUE	2	NEEDLES	CA	92363	3105	00	06000	34.830963	-114.6183555	San Bernardino County
326025	Ordering, Referring, Prescribing	N/A	1255640942	0	0	JONES, EMILY J LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97024	N/A	N/A	N/A	N/A	N/A	988 MCCOURTNEY RD	STE. 102	GRASS VALLEY	CA	95949	7400	00	06000	39.2089732	-121.0729043	Nevada County
326035	Ordering, Referring, Prescribing	N/A	1255668539	0	0	JONES, CAROL D LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	28503	N/A	N/A	N/A	N/A	N/A	360 S HOPE AVE	C205	SANTA BARBARA	CA	93105	4017	00	06000	34.43483946	-119.7472231	Santa Barbara County
326106	Ordering, Referring, Prescribing	N/A	1255781092	0	0	JUAREZ, GUADALUPE J LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118626	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
326136	Ordering, Referring, Prescribing	N/A	1255829479	0	0	JUNG, HYEYOUNG LCSW	10/29/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79621	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
326142	Ordering, Referring, Prescribing	N/A	1255846390	0	0	JOHNSON, STEVEN LCSW	6/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89667	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
326145	Ordering, Referring, Prescribing	N/A	1255841581	0	0	JAN, JULIANN PHARMD	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77047	N/A	N/A	N/A	N/A	N/A	3850 VALLEY CENTER DRIVE	None	SAN DIEGO	CA	92130	2331	00	06000	32.93777252	-117.2318423	San Diego County
326215	Ordering, Referring, Prescribing	N/A	1255956314	0	0	JACKSON, GRACIE E NP	8/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015149	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
326223	Ordering, Referring, Prescribing	N/A	1255979852	0	0	JONES, JESSICA PHARMD	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	81547	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
326231	Ordering, Referring, Prescribing	N/A	1255989083	0	0	JACOBS, JULIANNE	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124835	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
326249	Ordering, Referring, Prescribing	N/A	1265025845	0	0	JONES, LINDA L NP	2/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016451	N/A	N/A	N/A	N/A	N/A	69175 RAMON ROAD	BUILDING A	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
326365	Ordering, Referring, Prescribing	N/A	1265556807	0	0	JENSEN, LISA H LMFT	11/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT25593	N/A	N/A	N/A	N/A	N/A	303 POTRERO ST.	56	SANTA CRUZ	CA	95060	2760	00	06000	36.98079126	-122.030791	Santa Cruz County
326400	Ordering, Referring, Prescribing	N/A	1265628911	0	0	JOLLIFF, JEFFREY PHARMD	5/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	10465	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
326477	Ordering, Referring, Prescribing	N/A	1265753263	0	0	JANOWAK, CHRISTOPHER	7/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	35129125	N/A	N/A	N/A	N/A	N/A	234 GOODMAN STREET	None	CINCINNATI	OH	45219	2316	00	06000	39.13677965	-84.5023814	Hamilton County
326546	Ordering, Referring, Prescribing	N/A	1265867832	0	0	JEON, SUJIN LCSW	2/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85560	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
326559	Ordering, Referring, Prescribing	N/A	1265878938	0	0	JUAREZ SANCHEZ, MARIA G LCSW	2/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87876	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
326631	Ordering, Referring, Prescribing	N/A	1275014441	0	0	JOSLIN-GAY, ERIN NP	4/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029961	N/A	N/A	N/A	N/A	N/A	1 HAWTHORNE ST	SUITE 23D	SAN FRANCISCO	CA	94105	3984	00	06000	37.78564929	-122.3990268	San Francisco County
326633	Ordering, Referring, Prescribing	N/A	1275016156	0	0	JIMENEZ, ANGELICA G NP	4/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020669	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
326653	Ordering, Referring, Prescribing	N/A	1275058075	0	0	JACOBO, MARISOL MSW LCSW	1/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99771	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
326678	Ordering, Referring, Prescribing	N/A	1275100885	0	0	JOBIN, PARKER G MD	12/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187881	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
326991	Ordering, Referring, Prescribing	N/A	1275981896	0	0	JEPSEN, CINDY LMFT	9/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117213	N/A	N/A	N/A	N/A	N/A	12 GRACELAND DR	None	SAN RAFAEL	CA	94901	1922	00	06000	37.98110915	-122.5260099	Marin County
327030	Ordering, Referring, Prescribing	N/A	1285019356	0	0	JONES, AMBER LCSW	2/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94104	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
327050	Ordering, Referring, Prescribing	N/A	1285058511	0	0	JOHNSON, ERIC LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT27268	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
327106	Ordering, Referring, Prescribing	N/A	1285128827	0	0	JONES, TIMOTHY CRNA	3/6/2024	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	NA95001285	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
327175	Ordering, Referring, Prescribing	N/A	1285251280	0	0	JOO, YUNICHEL MD	9/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190151	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	1602	00	06000	34.06176363	-118.2932622	Los Angeles County
327205	Ordering, Referring, Prescribing	N/A	1285345553	0	0	JENKINS, ELIZABETH A LCSW	7/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	13350	N/A	N/A	N/A	N/A	N/A	27335 WEATHERSFIELD DR	None	VALENCIA	CA	91354	1900	00	06000	34.4435429	-118.5434558	Los Angeles County
327210	Ordering, Referring, Prescribing	N/A	1285349241	0	0	JOHNSTONE, ERICA LMFT	4/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131576	N/A	N/A	N/A	N/A	N/A	4250 FOWLER LN	UNIT 204	DIAMOND SPRINGS	CA	95619	9781	00	06000	38.69331583	-120.8130299	El Dorado County
327225	Ordering, Referring, Prescribing	N/A	1285388413	0	0	JAIN, NIMISHA PA-C	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60599	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE	STE 100	NEWPORT BEACH	CA	92660	8105	00	06000	33.66641504	-117.857408	Orange County
327243	Ordering, Referring, Prescribing	N/A	1285483693	0	0	JIMENEZ, VERONICA PHARMD	12/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81897	N/A	N/A	N/A	N/A	N/A	2100 W 3RD ST	SUITE 190	LOS ANGELES	CA	90057	1944	00	06000	34.06308947	-118.2733326	Los Angeles County
327248	Ordering, Referring, Prescribing	N/A	1285622175	0	0	JACKSON, LEON MD	7/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68430	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
327352	Ordering, Referring, Prescribing	N/A	1285902213	0	0	JAFARI, MARY H	7/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52615	N/A	N/A	N/A	N/A	N/A	1932 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5606	00	06000	34.03121204	-118.4833937	Los Angeles County
327438	Ordering, Referring, Prescribing	N/A	1295049229	0	0	JOHNSON, CHRISTINE NP	5/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20022	N/A	N/A	N/A	N/A	N/A	286 EUCLID AVE	102	SAN DIEGO	CA	92114	3610	00	06000	32.70706919	-117.0850896	San Diego County
327506	Ordering, Referring, Prescribing	N/A	1295181295	0	0	JACKSON, SASHA LCSW	9/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96641	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
327513	Ordering, Referring, Prescribing	N/A	1295197606	0	0	JUN-IHN, ESTHER MD FAAP	9/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152561	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	1234	00	06000	34.06633051	-118.4452686	Los Angeles County
327523	Ordering, Referring, Prescribing	N/A	1295214195	0	0	JONES, WENDY P	5/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	2818	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
327610	Ordering, Referring, Prescribing	N/A	1295355261	0	0	JAVETE, ELLEN B	10/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34027	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
327750	Ordering, Referring, Prescribing	N/A	1295958353	0	0	JAVID, HOSSEIN DDS	11/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48616	N/A	N/A	N/A	N/A	N/A	3831 HUGHES AVE	102	CULVER CITY	CA	90232	2751	00	06000	34.02243278	-118.3981492	Los Angeles County
327869	Ordering, Referring, Prescribing	N/A	1306181193	0	0	JUNG, ANNA H MD	1/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138221	N/A	N/A	N/A	N/A	N/A	375 89TH STREET	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
327880	Ordering, Referring, Prescribing	N/A	1306197819	0	0	JIMENEZ, JESSICA M PA-C	8/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	22326	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
327956	Ordering, Referring, Prescribing	N/A	1306310982	0	0	JAIME, MONICA	12/12/2018	Taxonomy not applicable	NA	n/a	013	HEARING AID DISPENSERS	HA8442	N/A	N/A	N/A	N/A	N/A	5385 WALNUT AVE	STE. 8	CHINO	CA	91710	2605	00	06000	34.02627451	-117.6872175	San Bernardino County
327973	Ordering, Referring, Prescribing	N/A	1306346986	0	0	JANUARY, MARLON C LMFT	2/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT145122	N/A	N/A	N/A	N/A	N/A	4700 SUMMERTREE LN	B	BAKERSFIELD	CA	93309	4824	00	06000	35.33709979	-119.0535873	Kern County
328002	Ordering, Referring, Prescribing	N/A	1306407689	0	0	JANSEN, MADELINE MD MPH	2/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179321	N/A	N/A	N/A	N/A	N/A	10549 JEFFERSON BLVD	None	CULVER CITY	CA	90232	3513	00	06000	34.00659325	-118.3923586	Los Angeles County
328083	Ordering, Referring, Prescribing	N/A	1306694856	0	0	JONES, LATOYA L LMFT	3/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT142524	N/A	N/A	N/A	N/A	N/A	3281 E GUASTI RD	SUITE 600	ONTARIO	CA	91761	7622	00	06000	34.065063	-117.5799015	San Bernardino County
328163	Ordering, Referring, Prescribing	N/A	1316013618	0	0	JONGEWAARD, LISA	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0515755	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
328172	Ordering, Referring, Prescribing	N/A	1316026842	0	0	JUSTICE, EUNJOO L MD	11/21/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42018	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
328198	Ordering, Referring, Prescribing	N/A	1316074230	0	0	JONES, ASHLEY M LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89455	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
328204	Ordering, Referring, Prescribing	N/A	1316085608	0	0	JULIAN, LORI OT	3/3/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT325	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
328273	Ordering, Referring, Prescribing	N/A	1316247141	0	0	JIMENEZ, RANDY S PHARMD	10/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	63184	N/A	N/A	N/A	N/A	N/A	515 W WASHINGTON ST	None	SAN DIEGO	CA	92103	1986	00	06000	32.74978816	-117.168151	San Diego County
328321	Ordering, Referring, Prescribing	N/A	1316323447	0	0	JAMES, KENDRA J NP	3/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008969	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO	None	SANTA BARBARA	CA	93105	4343	00	06000	34.42887662	-119.7237878	Santa Barbara County
328386	Ordering, Referring, Prescribing	N/A	1316422017	0	0	JACOBS, ETSUKO T NP	9/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010027	N/A	N/A	N/A	N/A	N/A	1600 FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
328422	Ordering, Referring, Prescribing	N/A	1316470263	0	0	JANUARY, MIRACLE M LMFT	7/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125804	N/A	N/A	N/A	N/A	N/A	3281 E GUASTI RD	440	ONTARIO	CA	91761	7622	00	06000	34.065063	-117.5799015	San Bernardino County
328458	Ordering, Referring, Prescribing	N/A	1316522253	0	0	JACOB, JEENA NP	1/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016908	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
328508	Ordering, Referring, Prescribing	N/A	1316616907	0	0	JANKEEL, NASHWA	6/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84445	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
328595	Ordering, Referring, Prescribing	N/A	1326130261	0	0	JUNG, PEGGY	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55700	N/A	N/A	N/A	N/A	N/A	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	00	06000	37.43378232	-121.8920598	Santa Clara County
328631	Ordering, Referring, Prescribing	N/A	1326176777	0	0	JARA, JESSICA LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121495	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
328632	Ordering, Referring, Prescribing	N/A	1326177072	0	0	JEFFERSON, DEXTER J CSW	8/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75049	N/A	N/A	N/A	N/A	N/A	921 S BEACON ST	None	SAN PEDRO	CA	90731	3740	00	06000	33.73553795	-118.2805075	Los Angeles County
328641	Ordering, Referring, Prescribing	N/A	1326193632	0	0	JOHNSON, JAN M MD	5/27/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67007	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
328681	Ordering, Referring, Prescribing	N/A	1326282690	0	0	JUBB, ALEXANDER E	11/9/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D57315	N/A	N/A	N/A	N/A	N/A	4700 N RIVER RD	STE B	OCEANSIDE	CA	92057	6043	00	06000	33.24542735	-117.3092006	San Diego County
328738	Ordering, Referring, Prescribing	N/A	1326337650	0	0	JELAVIC, IVANA LPCC	3/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7716	N/A	N/A	N/A	N/A	N/A	117 N R ST	101	MADERA	CA	93637	4465	00	06000	36.95311832	-120.0734055	Madera County
328748	Ordering, Referring, Prescribing	N/A	1326362823	0	0	JONES, IAN M MD	2/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120935	N/A	N/A	N/A	N/A	N/A	500 WEST FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
328784	Ordering, Referring, Prescribing	N/A	1326422049	0	0	JORDAN, LYDIA G LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104415	N/A	N/A	N/A	N/A	N/A	5740 RALSTON STREET	100	VENTURA	CA	93003	7487	00	06000	34.26070802	-119.213699	Ventura County
328828	Ordering, Referring, Prescribing	N/A	1326482597	0	0	JORDAN, JOSHUA MD	2/26/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162942	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
328839	Ordering, Referring, Prescribing	N/A	1326497835	0	0	JASKER, BRITTANY LCSW	6/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88127	N/A	N/A	N/A	N/A	N/A	6762 LEXINGTON AVE	None	LOS ANGELES	CA	90038	1217	00	06000	34.09253848	-118.3378635	Los Angeles County
328848	Ordering, Referring, Prescribing	N/A	1326517426	0	0	JONES, KATIE L	12/10/2019	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM546	N/A	N/A	N/A	N/A	N/A	53201 ROCKMERE DR.	None	IDYLLWILD	CA	92549	2397	00	06000	33.76071569	-116.7356963	Riverside County
328849	Ordering, Referring, Prescribing	N/A	1326518325	0	0	JOHNSTON, KAREN R MD	7/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G67445	N/A	N/A	N/A	N/A	N/A	240 SPRUCE ST	None	GRIDLEY	CA	95948	2216	00	06000	39.36701046	-121.6895355	Butte County
328851	Ordering, Referring, Prescribing	N/A	1326525296	0	0	JENG, AMORETTE A PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76852	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
328866	Ordering, Referring, Prescribing	N/A	1326549858	0	0	JOHNSON, JOALEEN R RN PNP	1/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012753	N/A	N/A	N/A	N/A	N/A	2310 1ST ST	None	NAPA	CA	94559	2239	00	06000	38.29806271	-122.2989388	Napa County
328987	Ordering, Referring, Prescribing	N/A	1326804253	0	0	JHO, EVELINE NP	7/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026093	N/A	N/A	N/A	N/A	N/A	27800 1/2 MEDICAL CENTER	STE 110P	MISSION VIEJO	CA	92691	6413	00	06000	33.55952733	-117.6645199	Orange County
328995	Ordering, Referring, Prescribing	N/A	1336152099	0	0	JAMEI, MOHSEN MD	1/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84432	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
329050	Ordering, Referring, Prescribing	N/A	1336305127	0	0	JOHNSTON-BARTON, ASHLEIGH V LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39698	N/A	N/A	N/A	N/A	N/A	423 CHAPALA ST	None	SANTA BARBARA	CA	93101	3409	00	06000	34.41532813	-119.6961695	Santa Barbara County
329102	Ordering, Referring, Prescribing	N/A	1336419225	0	0	JIMENEZ, RUBY A LCSW	11/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98551	N/A	N/A	N/A	N/A	N/A	3230 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96037915	-122.5019455	Marin County
329130	Ordering, Referring, Prescribing	N/A	1336471630	0	0	JORDAN-CHURCH, MARY E LCSW	7/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS24068	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
329194	Ordering, Referring, Prescribing	N/A	1336543487	0	0	JERDEVA, GALINA V PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68767	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
329210	Ordering, Referring, Prescribing	N/A	1336572999	0	0	JEROMINSKI, MARILYN PHARMD	8/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62053	N/A	N/A	N/A	N/A	N/A	44840 MONTEREY AVE	None	PALM DESERT	CA	92260	9226	00	06000	33.722667	-116.391222	Riverside County
329230	Ordering, Referring, Prescribing	N/A	1336603778	0	0	JACOBSON, KATHERINE LMFT	1/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144392	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST. #103	103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
329264	Ordering, Referring, Prescribing	N/A	1336652916	0	0	JEON, DIANA PHARMD	2/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77584	N/A	N/A	N/A	N/A	N/A	26800 CROWN VALLEY PKWY	185	MISSION VIEJO	CA	92691	2217	00	06000	33.56286021	-117.6673449	Orange County
329308	Ordering, Referring, Prescribing	N/A	1336723006	0	0	JONES, CHRISTINA M CNP	3/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015542	N/A	N/A	N/A	N/A	N/A	9226 N HINTON AVE	None	DELHI	CA	95315	0339	00	06000	37.42229366	-120.7771653	Merced County
329329	Ordering, Referring, Prescribing	N/A	1336774694	0	0	JENSEN, ANDRINA F LMFT	3/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138237	N/A	N/A	N/A	N/A	N/A	5168 HONPIE RD	None	PLACERVILLE	CA	95667	8635	00	06000	38.6943603	-120.9018271	El Dorado County
329387	Ordering, Referring, Prescribing	N/A	1346053121	0	0	JEBARAJ, BEULAH NP	1/24/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033700	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	0001	00	06000	34.95019447	-120.4147816	Santa Barbara County
329401	Ordering, Referring, Prescribing	N/A	1346223757	0	0	JORDAN, NAITTE P NP	3/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	4199	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
329415	Ordering, Referring, Prescribing	N/A	1346307014	0	0	JUMP, TIFFANY L LMFT	11/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43966	N/A	N/A	N/A	N/A	N/A	6060 PARAMOUNT BLVD	None	LONG BEACH	CA	90805	3711	00	06000	33.865083	-118.157517	Los Angeles County
329474	Ordering, Referring, Prescribing	N/A	1346425592	0	0	JONES, KEDRON E LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81240	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
329542	Ordering, Referring, Prescribing	N/A	1346544830	0	0	JOHNSON, MARCELLINA NP	1/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18245	N/A	N/A	N/A	N/A	N/A	555 S VERMONT AVE	None	LOS ANGELES	CA	90020	0000	00	06000	34.0640891	-118.2917177	Los Angeles County
329598	Ordering, Referring, Prescribing	N/A	1346642212	0	0	JOHNSON, AMANDA PA	12/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55230	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
329723	Ordering, Referring, Prescribing	N/A	1346852480	0	0	JUENGER, JENNA NP	6/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95015176	N/A	N/A	N/A	N/A	N/A	1685 E MAIN ST	301	EL CAJON	CA	92021	5225	00	06000	32.81132509	-116.9192044	San Diego County
329730	Ordering, Referring, Prescribing	N/A	1346862349	0	0	JOSEPH, SHAINA L PSYD	3/15/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34933	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	259	OAKLAND	CA	94601	9460	00	06000	37.77617499	-122.2247899	Alameda County
329731	Ordering, Referring, Prescribing	N/A	1346876679	0	0	JANI, DHARA LMFT	2/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131106	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
329850	Ordering, Referring, Prescribing	N/A	1356450159	0	0	JOHNSON, PHILLIP R DDS	10/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS51943	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
329868	Ordering, Referring, Prescribing	N/A	1356498612	0	0	JEFFERSON-GLIPA, FRANCIS LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42577	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
329870	Ordering, Referring, Prescribing	N/A	1356503882	0	0	JANDIAL, SONAL DO	9/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11599	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
329885	Ordering, Referring, Prescribing	N/A	1356524482	0	0	JAMES, NOELLE R LCSW	2/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25831	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	None	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
329923	Ordering, Referring, Prescribing	N/A	1356610869	0	0	JAUREGUI, CHRISTINA O LMFT	12/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103677	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
329928	Ordering, Referring, Prescribing	N/A	1356621510	0	0	JOHNSON, CYNTHIA R LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91069	N/A	N/A	N/A	N/A	N/A	525 CABRILLO PARK DR	300	SANTA ANA	CA	92701	5017	00	06000	33.75047365	-117.8404984	Orange County
329929	Ordering, Referring, Prescribing	N/A	1356624688	0	0	JAMISON, LAISA C LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76427	N/A	N/A	N/A	N/A	N/A	4850 PEDLEY RD	None	NORCO	CA	92509	3966	00	06000	34.0005919	-117.4753694	Riverside County
330005	Ordering, Referring, Prescribing	N/A	1356725840	0	0	JACKSON, AMANDA L LPCC	5/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC11586	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
330045	Ordering, Referring, Prescribing	N/A	1356786297	0	0	JONES, LEAH M LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115850	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
330093	Ordering, Referring, Prescribing	N/A	1356882286	0	0	JUCKEM, KORA A NP	12/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95179133	N/A	N/A	N/A	N/A	N/A	4225 EXECUTIVE SQUARE	600	LA JOLLA	CA	92037	1484	00	06000	32.87406185	-117.2156778	San Diego County
330105	Ordering, Referring, Prescribing	N/A	1356897417	0	0	JONES, TERI J LMFT	6/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126530	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
330294	Ordering, Referring, Prescribing	N/A	1366584799	0	0	JARJOUR, GEORGE L	5/17/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D43448	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
330297	Ordering, Referring, Prescribing	N/A	1366585499	0	0	JERNAZIAN-KANAIAN, IRENE	12/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64103	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
330318	Ordering, Referring, Prescribing	N/A	1366637993	0	0	JACKSON, ANITA I LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94587	N/A	N/A	N/A	N/A	N/A	2311 LOVERIDGE RD	None	PITTSBURG	CA	94565	5117	00	06000	38.00694767	-121.8712439	Contra Costa County
330322	Ordering, Referring, Prescribing	N/A	1366646978	0	0	JUNG, THELMA LCSW	9/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92900	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
330412	Ordering, Referring, Prescribing	N/A	1366828154	0	0	JENSEN, CHELSEA L LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117256	N/A	N/A	N/A	N/A	N/A	403 W. MORRISON AVE.	None	SANTA MARIA	CA	93458	8166	00	06000	34.94319568	-120.4411316	Santa Barbara County
330460	Ordering, Referring, Prescribing	N/A	1366883696	0	0	JACKSON, EMILY A	12/12/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D62206	N/A	N/A	N/A	N/A	N/A	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1304	00	06000	33.5230101	-117.6683028	Orange County
330470	Ordering, Referring, Prescribing	N/A	1366908535	0	0	JEWETT, ELINOR S LMFT	3/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94789	N/A	N/A	N/A	N/A	N/A	1339 20TH STREET	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
330697	Ordering, Referring, Prescribing	N/A	1376647651	0	0	JOSEPHSON, WILLIAM Y MD	6/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44225	N/A	N/A	N/A	N/A	N/A	2100 E. ANAHEIM ST.	STE B	LONG BEACH	CA	90804	3419	00	06000	33.7825725	-118.1663865	Los Angeles County
330753	Ordering, Referring, Prescribing	N/A	1376767350	0	0	JUNG, CHRISTINA LCSW	11/21/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19401	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
330779	Ordering, Referring, Prescribing	N/A	1376822999	0	0	JABLON, STACIE LMFT	1/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36550	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
330799	Ordering, Referring, Prescribing	N/A	1376865063	0	0	JACKSON, ELIZABETH S LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49765	N/A	N/A	N/A	N/A	N/A	327 COLLEGE AVE	None	SANTA ROSA	CA	95401	5117	00	06000	38.445957	-122.7215205	Sonoma County
330821	Ordering, Referring, Prescribing	N/A	1376890210	0	0	JONDLE, BRITTANY E PSYD	3/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29561	N/A	N/A	N/A	N/A	N/A	301 THE CITY DRIVE S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
330867	Ordering, Referring, Prescribing	N/A	1376965095	0	0	JIMENEZ, DEANNA LMFT	9/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89989	N/A	N/A	N/A	N/A	N/A	3255 WING STREET	None	SAN DIEGO	CA	92110	4642	00	06000	32.74951073	-117.2129422	San Diego County
330904	Ordering, Referring, Prescribing	N/A	1386018463	0	0	JONES, ERIBEL L CCC-SLP	8/9/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	35604	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170/180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
330914	Ordering, Referring, Prescribing	N/A	1386027084	0	0	JEUN, SUJIN PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71094	N/A	N/A	N/A	N/A	N/A	18502 BEACH BLVD	116	HUNTINGTON BEACH	CA	92648	0924	00	06000	33.693507	-117.988724	Orange County
330934	Ordering, Referring, Prescribing	N/A	1386043503	0	0	JACK, MICHELLE M LCSW	8/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96801	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	201	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
330998	Ordering, Referring, Prescribing	N/A	1386154433	0	0	JAMISON, MEGAN LCSW	11/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81722	N/A	N/A	N/A	N/A	N/A	5225 N LAKE BLVD	None	CARNELIAN BAY	CA	96140	6140	00	06000	39.22688547	-120.078288	Placer County
331019	Ordering, Referring, Prescribing	N/A	1386176774	0	0	JUNG, HYEEUN NP	1/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95062094	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	STE 9A	BUENA PARK	CA	90621	4667	00	06000	33.85890953	-118.007244	Orange County
331125	Ordering, Referring, Prescribing	N/A	1386482784	0	0	JAIN, SARA DDS	7/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110338	N/A	N/A	N/A	N/A	N/A	600 NUT TREE RD	STE 120	VACAVILLE	CA	95687	4669	00	06000	38.36133624	-121.9496789	Solano County
331144	Ordering, Referring, Prescribing	N/A	1386653194	0	0	JENSEN, AMY E	1/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19152	N/A	N/A	N/A	N/A	N/A	5417 MADISON AVE	None	SACRAMENTO	CA	95841	3164	00	06000	38.661273	-121.338117	Sacramento County
331281	Ordering, Referring, Prescribing	N/A	1386951465	0	0	JOHNSON, MARY A	5/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	21162	N/A	N/A	N/A	N/A	N/A	1433 N ACACIA AVE	None	REEDLEY	CA	93654	2102	00	06000	36.60898603	-119.4510614	Fresno County
331306	Ordering, Referring, Prescribing	N/A	1396003778	0	0	JAMES, LORI L	5/20/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0783860	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
331313	Ordering, Referring, Prescribing	N/A	1396011672	0	0	JONES, LISA C LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17043	N/A	N/A	N/A	N/A	N/A	3530 ATLANTIC AVE	None	LONG BEACH	CA	90807	4569	00	06000	33.820875	-118.1850035	Los Angeles County
331357	Ordering, Referring, Prescribing	N/A	1396089017	0	0	JIMENEZ, MICHELLE LPCC	10/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	7222	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92108	4711	00	06000	32.77025942	-117.2017196	San Diego County
331491	Ordering, Referring, Prescribing	N/A	1396291894	0	0	JANAIRO, BRIAN B LCSW	3/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100873	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
331546	Ordering, Referring, Prescribing	N/A	1396382651	0	0	JOSE-NAM, MARY ANNE R PHARMD	8/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80935	N/A	N/A	N/A	N/A	N/A	1213 FAIR OAKS AVE	None	SOUTH PASADENA	CA	91030	3805	00	06000	34.11153	-118.1505165	Los Angeles County
331563	Ordering, Referring, Prescribing	N/A	1396427605	0	0	JEFFREY, SARAH	10/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	ND1451	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
331565	Ordering, Referring, Prescribing	N/A	1396416442	0	0	JOSOWITZ, JULIA N	4/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61024	N/A	N/A	N/A	N/A	N/A	2500 CALIFORNIA ST.	None	MOUNTAIN VIEW	CA	94040	0000	00	06000	37.40337202	-122.1063817	Santa Clara County
331609	Ordering, Referring, Prescribing	N/A	1396760252	0	0	JEFFERY, JESSIE	4/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	19890	N/A	N/A	N/A	N/A	N/A	4760 S FIGUEROA ST	None	LOS ANGELES	CA	90037	3159	00	06000	33.99970148	-118.2826935	Los Angeles County
331623	Ordering, Referring, Prescribing	N/A	1396819561	0	0	JONES-SULLIVAN, NANELLE L MD	11/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G64660	N/A	N/A	N/A	N/A	N/A	1119 E MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
331740	Ordering, Referring, Prescribing	N/A	1407014145	0	0	JAMES, CARLISSA T LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49856	N/A	N/A	N/A	N/A	N/A	1833 W. MARCH LN, SUITE	None	STOCKTON	CA	95207	6415	00	06000	37.9875446	-121.3283031	San Joaquin County
331782	Ordering, Referring, Prescribing	N/A	1407128259	0	0	JONES, KRISTA R	5/23/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0801355	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
331905	Ordering, Referring, Prescribing	N/A	1407344542	0	0	JOHNSTON, NICHOLAS S LCSW	4/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98260	N/A	N/A	N/A	N/A	N/A	345 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	1633	00	06000	34.04602976	-118.2429461	Los Angeles County
331926	Ordering, Referring, Prescribing	N/A	1407380165	0	0	JONES, ERIN F LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77503	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	120	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
332008	Ordering, Referring, Prescribing	N/A	1407661473	0	0	JAPE, SAMANTHA V NP	11/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032851	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
332025	Ordering, Referring, Prescribing	N/A	1407865660	0	0	JOHNSON, BRIAN D NP	7/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22980	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
332095	Ordering, Referring, Prescribing	N/A	1417031998	0	0	JORGE, BERNARD S MD	9/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33386	N/A	N/A	N/A	N/A	N/A	16415 COLORADO AVE	# 102	PARAMOUNT	CA	90723	5035	00	06000	33.8853075	-118.1614695	Los Angeles County
332129	Ordering, Referring, Prescribing	N/A	1417087669	0	0	JEFFRIES, CHERIE L LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44067	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
332166	Ordering, Referring, Prescribing	N/A	1417158981	0	0	JOHAL, SUKHI MD	7/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54912	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	200	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
332170	Ordering, Referring, Prescribing	N/A	1417159997	0	0	JINICH, CAREN LMFT	5/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35140	N/A	N/A	N/A	N/A	N/A	1400 E JANSS RD	None	THOUSAND OAKS	CA	91362	2133	00	06000	34.19964827	-118.8541386	Ventura County
332301	Ordering, Referring, Prescribing	N/A	1417390345	0	0	JONES, ERIN A MD	5/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142366	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
332380	Ordering, Referring, Prescribing	N/A	1417517848	0	0	JENSEN, CHRISTINE M LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21568	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
332551	Ordering, Referring, Prescribing	N/A	1427207430	0	0	JIMENEZ DUENAS, BEATRIZ LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82239	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
332611	Ordering, Referring, Prescribing	N/A	1427323179	0	0	JOHNSON, ANNA R LCSW	11/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92930	N/A	N/A	N/A	N/A	N/A	2814 W. MARTIN LUTHER KI	None	LOS ANGELES	CA	90008	2748	00	06000	34.01082949	-118.323828	Los Angeles County
332613	Ordering, Referring, Prescribing	N/A	1427341072	0	0	JOHNSON, JULIE D LCSW	7/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86815	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
332637	Ordering, Referring, Prescribing	N/A	1427383850	0	0	JAWAID, BUSHRA MD	5/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107456	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
332639	Ordering, Referring, Prescribing	N/A	1427401587	0	0	JADID, OMAR M LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112341	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	STE #100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
332652	Ordering, Referring, Prescribing	N/A	1427416957	0	0	JOHNSON, LAUREN E LCSW	5/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107566	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	BUILDING 80/90	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
332672	Ordering, Referring, Prescribing	N/A	1427452648	0	0	JONES, DUSTIN PA-C	2/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	56982	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
332675	Ordering, Referring, Prescribing	N/A	1427463041	0	0	JONES, IMELDA LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111499	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
332700	Ordering, Referring, Prescribing	N/A	1427488634	0	0	JIMENEZ, MARIA E LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27424	N/A	N/A	N/A	N/A	N/A	1661 N RAYMOND AVE	SUITE 200	ANAHEIM	CA	92801	1120	00	06000	33.858234	-117.906788	Orange County
332743	Ordering, Referring, Prescribing	N/A	1427554807	0	0	JONES, APRIL D LMFT	7/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89081	N/A	N/A	N/A	N/A	N/A	248 N THOMPSON AVE	None	HEMET	CA	92545	3334	00	06000	33.750234	-116.9651101	Riverside County
332759	Ordering, Referring, Prescribing	N/A	1427580182	0	0	JACOBS, MATTHEW A DO	6/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18993	N/A	N/A	N/A	N/A	N/A	228 HAMILTON AVE	329	PALO ALTO	CA	94301	2583	00	06000	37.44408197	-122.1613171	Santa Clara County
332809	Ordering, Referring, Prescribing	N/A	1427666775	0	0	JORDAN, TAMARA J LCSW	3/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100591	N/A	N/A	N/A	N/A	N/A	215 5TH ST	150	MARYSVILLE	CA	95901	0100	00	06000	39.14051769	-121.5868454	Yuba County
332815	Ordering, Referring, Prescribing	N/A	1427698075	0	0	JONES, NAOMI KATHRYNE LMFT	3/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138774	N/A	N/A	N/A	N/A	N/A	1136 DE LA VINA ST	None	SANTA BARBARA	CA	93101	3114	00	06000	34.42108243	-119.7064185	Santa Barbara County
332828	Ordering, Referring, Prescribing	N/A	1427744747	0	0	JAY, ALAN DDS	2/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108625	N/A	N/A	N/A	N/A	N/A	124 W MAIN ST	None	EL CAJON	CA	92020	3963	00	06000	32.79498825	-116.9630082	San Diego County
332831	Ordering, Referring, Prescribing	N/A	1427771385	0	0	JUAREZ, OLIVIA C	9/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022469	N/A	N/A	N/A	N/A	N/A	4682 ABBOTSWOOD CIR	None	IRVINE	CA	92604	2319	00	06000	33.69491825	-117.782087	Orange County
332835	Ordering, Referring, Prescribing	N/A	1427769504	0	0	JONES, ALPHONSO J NP	12/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95023565	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
332839	Ordering, Referring, Prescribing	N/A	1427785203	0	0	JEN, MELISSA LCSW	3/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104188	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
332842	Ordering, Referring, Prescribing	N/A	1427795483	0	0	JOE, MICHAEL PHARMD	9/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85923	N/A	N/A	N/A	N/A	N/A	2275 PINE ST	None	REDDING	CA	96001	2600	00	06000	40.57708137	-122.3863936	Shasta County
332905	Ordering, Referring, Prescribing	N/A	1437279965	0	0	JOHNSON, KRISTY A LMFT	5/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90676	N/A	N/A	N/A	N/A	N/A	2101 GEER RD.	120	TURLOCK	CA	95380	5496	00	06000	37.512324	-120.8489985	Stanislaus County
333036	Ordering, Referring, Prescribing	N/A	1437484839	0	0	JONES, CREOLA N LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46675	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVEUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
333162	Ordering, Referring, Prescribing	N/A	1437649704	0	0	JIANG, NING	5/2/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82266	N/A	N/A	N/A	N/A	N/A	767 N. HILL ST	SUITE 400B	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
333222	Ordering, Referring, Prescribing	N/A	1437772373	0	0	JOSE, SHARON MD	5/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196503	N/A	N/A	N/A	N/A	N/A	456 MONTGOMERY ST	SUITE 1400	SAN FRANCISCO	CA	94104	1233	00	06000	37.79345321	-122.4028473	San Francisco County
333234	Ordering, Referring, Prescribing	N/A	1437789898	0	0	JAENA, ELIZABETH NP	12/9/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013476	N/A	N/A	N/A	N/A	N/A	915 W 7TH ST	None	OXNARD	CA	93030	6755	00	06000	34.19516388	-119.1889217	Ventura County
333440	Ordering, Referring, Prescribing	N/A	1447559307	0	0	JANA, RIA	6/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61258	N/A	N/A	N/A	N/A	N/A	7141 N CEDAR AVE	104	FRESNO	CA	93720	3327	00	06000	36.83991418	-119.7558344	Fresno County
333481	Ordering, Referring, Prescribing	N/A	1447642566	0	0	JOHNSON, BRIDIE M LCSW	2/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120229	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
333501	Ordering, Referring, Prescribing	N/A	1447680665	0	0	JANUTA, MARCELE	3/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99292	N/A	N/A	N/A	N/A	N/A	24301 SOUTHLAND DR	600	HAYWARD	CA	94545	1542	00	06000	37.65344508	-122.1045736	Alameda County
333504	Ordering, Referring, Prescribing	N/A	1447683206	0	0	JENSEN LEWIS, DONNA LMFT	9/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102435	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
333560	Ordering, Referring, Prescribing	N/A	1447760236	0	0	JOHNSON, JENNIFER N RN	9/24/2017	Taxonomy not applicable	NA	n/a	000	Unknown	775703	N/A	N/A	N/A	N/A	N/A	3100 ACTIS RD	None	BAKERSFIELD	CA	93309	5911	00	06000	35.326998	-119.052223	Kern County
333584	Ordering, Referring, Prescribing	N/A	1447803325	0	0	JONES, SHERI E	3/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	104093	N/A	N/A	N/A	N/A	N/A	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4238	00	06000	34.045119	-117.6464565	San Bernardino County
333611	Ordering, Referring, Prescribing	N/A	1447863279	0	0	JUAREZ, ANISSA S	3/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128975	N/A	N/A	N/A	N/A	N/A	2500 S C ST	None	OXNARD	CA	93033	4560	00	06000	34.17646093	-119.1812737	Ventura County
333626	Ordering, Referring, Prescribing	N/A	1447922679	0	0	JARAKIAN, SARKIS	2/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59645	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	155	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
333630	Ordering, Referring, Prescribing	N/A	1447929997	0	0	JACOBSON, RUTH M NP	8/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018243	N/A	N/A	N/A	N/A	N/A	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	00	06000	33.849909	-117.9416115	Orange County
333685	Ordering, Referring, Prescribing	N/A	1457325797	0	0	JUVVADI, ANITA R MD	4/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55484	N/A	N/A	N/A	N/A	N/A	9460 N NAME UNO	None	GILROY	CA	95020	3537	00	06000	37.037781	-121.570965	Santa Clara County
333785	Ordering, Referring, Prescribing	N/A	1457585523	0	0	JURSA, LINDA S NP	1/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18152	N/A	N/A	N/A	N/A	N/A	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
333803	Ordering, Referring, Prescribing	N/A	1457630931	0	0	JAMES, KRISTIN D DO	9/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2635	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
333859	Ordering, Referring, Prescribing	N/A	1457721557	0	0	JOHNSON, RACHEL J LCSW	9/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110341	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE SUITE	None	BAKERSFIELD	CA	93309	2153	00	06000	35.429463	-119.0213795	Kern County
333863	Ordering, Referring, Prescribing	N/A	1457728933	0	0	JIMENEZ, DESIREE LCSW	12/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98901	N/A	N/A	N/A	N/A	N/A	1126 N GRAND AVE	D	COVINA	CA	91724	1551	00	06000	34.100082	-117.8724825	Los Angeles County
333921	Ordering, Referring, Prescribing	N/A	1457813560	0	0	JIMENEZ, JAVIER MD	3/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179934	N/A	N/A	N/A	N/A	N/A	1731 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92461329	-118.2426436	Los Angeles County
333952	Ordering, Referring, Prescribing	N/A	1457843955	0	0	JONES, MARY J NP	6/18/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	300415	N/A	N/A	N/A	N/A	N/A	4667 TELEGRAPH RD	None	VENTURA	CA	93003	3872	00	06000	34.27558442	-119.2316256	Ventura County
334108	Ordering, Referring, Prescribing	N/A	1467200287	0	0	JULIAN, JENNIFER LMFT	5/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130434	N/A	N/A	N/A	N/A	N/A	1400 E JANSS RD	None	THOUSAND OAKS	CA	91362	2133	00	06000	34.19964827	-118.8541386	Ventura County
334171	Ordering, Referring, Prescribing	N/A	1467577072	0	0	JENSEN, TIINA OT	4/8/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT2375	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
334183	Ordering, Referring, Prescribing	N/A	1467599274	0	0	JANG, EUN SUB DDS	10/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48468	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
334191	Ordering, Referring, Prescribing	N/A	1467576751	0	0	JOHNS, ALEXIS PHD	3/8/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20686	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD. MS#96	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
334240	Ordering, Referring, Prescribing	N/A	1467715672	0	0	JAVANFARD, ELAN LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87054	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
334282	Ordering, Referring, Prescribing	N/A	1467788737	0	0	JURANOVICH, PAUL G LMFT	11/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52218	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	225	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
334316	Ordering, Referring, Prescribing	N/A	1467832493	0	0	JEONG, JOHN	9/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72543	N/A	N/A	N/A	N/A	N/A	27220 SUN CITY BLVD	None	SUN CITY	CA	92586	2566	00	06000	33.71273441	-117.1937643	Riverside County
334322	Ordering, Referring, Prescribing	N/A	1467835371	0	0	JONES, MARISSA LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94531	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
334337	Ordering, Referring, Prescribing	N/A	1467866921	0	0	JOHNSON, TRISHIA DDS	9/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS63366	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
334417	Ordering, Referring, Prescribing	N/A	1467970889	0	0	JIMENEZ, ELIZABETH LCSW	3/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100356	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
334463	Ordering, Referring, Prescribing	N/A	1477048692	0	0	JOHNSON, MINDY LCSW	9/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97965	N/A	N/A	N/A	N/A	N/A	1755 AIRPORT BLVD	None	RED BLUFF	CA	96080	4514	00	06000	40.15638592	-122.2505326	Tehama County
334480	Ordering, Referring, Prescribing	N/A	1477079994	0	0	JABER, JASON DDS	5/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS101685	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	1110	00	06000	38.26876442	-122.6598332	Sonoma County
334498	Ordering, Referring, Prescribing	N/A	1477106383	0	0	JOHNSON, ANITA L NP	7/14/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011387	N/A	N/A	N/A	N/A	N/A	3349 G ST	SUITE C	MERCED	CA	95340	0993	00	06000	37.32432497	-120.4693064	Merced County
334546	Ordering, Referring, Prescribing	N/A	1477225985	0	0	JEMERA, JASON N NP	9/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018642	N/A	N/A	N/A	N/A	N/A	8233 E. STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
334583	Ordering, Referring, Prescribing	N/A	1477538700	0	0	JULIET, KIRSTEN Q MD	10/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67729	N/A	N/A	N/A	N/A	N/A	333 LAWS AVENUE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
334596	Ordering, Referring, Prescribing	N/A	1477579472	0	0	JEFFERS, GREGORY A MD	4/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A37601	N/A	N/A	N/A	N/A	N/A	220 MAIN ST	None	BRAWLEY	CA	92227	2392	00	06000	32.9785707	-115.5387612	Imperial County
334600	Ordering, Referring, Prescribing	N/A	1477593721	0	0	JENSEN, HEATHER S PHD	1/20/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20377	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVENUE, 6TH	None	LONG BEACH	CA	90806	2301	00	06000	33.806097	-118.151378	Los Angeles County
334642	Ordering, Referring, Prescribing	N/A	1477676096	0	0	JACKSON-GARBER, DEVERA E LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38795	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVENUE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
334680	Ordering, Referring, Prescribing	N/A	1477753721	0	0	JIMENEZ, IMELDA NP	10/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8852	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
334688	Ordering, Referring, Prescribing	N/A	1477782639	0	0	JONES, ALLISON LMFT	7/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84790	N/A	N/A	N/A	N/A	N/A	8745 FOLSOM BLVD	None	SACRAMENTO	CA	95826	3709	00	06000	38.551896	-121.3793415	Sacramento County
334782	Ordering, Referring, Prescribing	N/A	1477928562	0	0	JACKSON, ANDRE N LMFT	11/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129229	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
334803	Ordering, Referring, Prescribing	N/A	1477953651	0	0	JOSHI, TUSHAR P PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65015	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
334814	Ordering, Referring, Prescribing	N/A	1477987204	0	0	JOYNER, JENNIFER LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65624	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
334837	Ordering, Referring, Prescribing	N/A	1477990810	0	0	JHAM, MENAL A MD	11/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137667	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
334854	Ordering, Referring, Prescribing	N/A	1487029146	0	0	JIN, MIAOQI	1/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	73028	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
334999	Ordering, Referring, Prescribing	N/A	1487235305	0	0	JOHANSEN, KEVIN MD	12/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200188	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
335005	Ordering, Referring, Prescribing	N/A	1487245866	0	0	JOHNSON, JASMINE M LMFT	3/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145992	N/A	N/A	N/A	N/A	N/A	480 CHADBOURNE RD	None	FAIRFIELD	CA	94534	9639	00	06000	38.23538389	-122.0821428	Solano County
335055	Ordering, Referring, Prescribing	N/A	1487378246	0	0	JIANG, KEVIN	10/24/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	108164	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
335087	Ordering, Referring, Prescribing	N/A	1487677589	0	0	JOHNSON, JULIUS M PHD	7/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY8821	N/A	N/A	N/A	N/A	N/A	3410 GEARY BLVD., SUITE	None	SAN FRANCISCO	CA	94118	3357	00	06000	37.78149475	-122.4557465	San Francisco County
335103	Ordering, Referring, Prescribing	N/A	1487720629	0	0	JOHNSON, NANCY D LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39707	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
335106	Ordering, Referring, Prescribing	N/A	1487721817	0	0	JACKSON, ELISHA D LCSW	5/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26325	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
335188	Ordering, Referring, Prescribing	N/A	1487895728	0	0	JONES, GINA LCSW	6/25/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29363	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
335216	Ordering, Referring, Prescribing	N/A	1487958757	0	0	JACKSON, RACHELLE	11/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69666	N/A	N/A	N/A	N/A	N/A	110 EAST D STREET	J	BENICIA	CA	94510	3252	00	06000	38.04718176	-122.1601414	Solano County
335233	Ordering, Referring, Prescribing	N/A	1487976387	0	0	JACKSON, MARK H LCSW	4/20/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60523	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
335237	Ordering, Referring, Prescribing	N/A	1487978011	0	0	JIMENEZ, ELIZABETH M LCSW	1/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29418	N/A	N/A	N/A	N/A	N/A	1800 GRAVENSTEIN HWY N	None	SEBASTOPOL	CA	95472	2607	00	06000	38.42104172	-122.8461197	Sonoma County
335296	Ordering, Referring, Prescribing	N/A	1497075311	0	0	JUNIOUS, SHAQUITA R LMFT	6/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106890	N/A	N/A	N/A	N/A	N/A	5715 S. BROADWAY	None	LOS ANGELES	CA	90037	4131	00	06000	33.990273	-118.2783255	Los Angeles County
335341	Ordering, Referring, Prescribing	N/A	1497155360	0	0	JIMENEZ, ROBERTO	5/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011085	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
335343	Ordering, Referring, Prescribing	N/A	1497159099	0	0	JUDGE, PARVINDER S PHARMD	8/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71766	N/A	N/A	N/A	N/A	N/A	1661 MCKEE RD	None	SAN JOSE	CA	95116	1236	00	06000	37.35773116	-121.8613412	Santa Clara County
335523	Ordering, Referring, Prescribing	N/A	1497707731	0	0	JAHANGIRI, HAMEED MD	3/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78392	N/A	N/A	N/A	N/A	N/A	1195 THIRD ST	None	NAPA	CA	94559	3048	00	06000	38.29729487	-122.2852872	Napa County
335630	Ordering, Referring, Prescribing	N/A	1508020843	0	0	JUAREZ, LAUREN E LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76787	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
335651	Ordering, Referring, Prescribing	N/A	1508063694	0	0	JOHNSON, DAVID W LMFT	9/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35499	N/A	N/A	N/A	N/A	N/A	3097 WILLOW #3	None	CLOVIS	CA	93612	4715	00	06000	36.79616247	-119.7272892	Fresno County
335711	Ordering, Referring, Prescribing	N/A	1508169483	0	0	JEHA, WILLIAM B PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	39127	N/A	N/A	N/A	N/A	N/A	3365 DEER VALLEY RD	None	ANTIOCH	CA	94531	6664	00	06000	37.98789856	-121.7855921	Contra Costa County
335742	Ordering, Referring, Prescribing	N/A	1508231648	0	0	JHEE, EUN PT	8/18/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	22230	N/A	N/A	N/A	N/A	N/A	909 S. FAIR OAKS AVE.	None	PASADENA	CA	91105	2625	00	06000	34.13056002	-118.1503751	Los Angeles County
335784	Ordering, Referring, Prescribing	N/A	1508291485	0	0	JIVAN, RACHANA PHARMD	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64911	N/A	N/A	N/A	N/A	N/A	880 SUTTON WAY	None	GRASS VALLEY	CA	95945	5167	00	06000	39.23520763	-121.0340543	Nevada County
335983	Ordering, Referring, Prescribing	N/A	1508921057	0	0	JUAREZ, REBECA R LCSW	7/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18340	N/A	N/A	N/A	N/A	N/A	401 THE CITY DR S	#46B	ORANGE	CA	92868	3303	00	06000	33.78395385	-117.8887742	Orange County
336004	Ordering, Referring, Prescribing	N/A	1508984931	0	0	JOHNSON, HEATHER L LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80841	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	None	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
336009	Ordering, Referring, Prescribing	N/A	1508995846	0	0	JONES DUZSA, CORIE	10/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46993	N/A	N/A	N/A	N/A	N/A	652 GRANTS PASS	None	REDDING	CA	96003	5226	00	06000	40.60070347	-122.3566245	Shasta County
336178	Ordering, Referring, Prescribing	N/A	1518320217	0	0	JEAN, ASHLEY MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162495	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
336212	Ordering, Referring, Prescribing	N/A	1518367887	0	0	JENG, HUNG-JIE CNP	4/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95001224	N/A	N/A	N/A	N/A	N/A	828 E VALLEY BLVD.	SUITE #C	SAN GABRIEL	CA	91776	3596	00	06000	34.08018612	-118.0895417	Los Angeles County
336408	Ordering, Referring, Prescribing	N/A	1528121712	0	0	JONES, FREDERIC H PSYD	8/28/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22736	N/A	N/A	N/A	N/A	N/A	509 COLLEGE STREET	None	WOODLAND	CA	95695	3910	00	06000	38.67545792	-121.7747146	Yolo County
336524	Ordering, Referring, Prescribing	N/A	1528356227	0	0	JAVIER, KIMBERLY N PHD	1/19/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33131	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
336567	Ordering, Referring, Prescribing	N/A	1528435708	0	0	JAYNES, AMANDA LMFT	5/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119789	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
336593	Ordering, Referring, Prescribing	N/A	1528469681	0	0	JACK, JORDAN LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89339	N/A	N/A	N/A	N/A	N/A	604 PEARL ST	None	MONTEREY	CA	93940	3070	00	06000	36.59779529	-121.8889498	Monterey County
336671	Ordering, Referring, Prescribing	N/A	1528599784	0	0	JIANG, SHASHA	9/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165248	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	3844	00	06000	34.05382447	-118.1363489	Los Angeles County
336674	Ordering, Referring, Prescribing	N/A	1528610185	0	0	JOHNSON, CYLE MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192245	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
336731	Ordering, Referring, Prescribing	N/A	1528728078	0	0	JHANG, HONGNAN NP	3/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022949	N/A	N/A	N/A	N/A	N/A	3663 W 6TH ST	100	LOS ANGELES	CA	90020	3049	00	06000	34.06360557	-118.30199	Los Angeles County
336791	Ordering, Referring, Prescribing	N/A	1538214697	0	0	JONES, RYLLE LMFT	10/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT37293	N/A	N/A	N/A	N/A	N/A	3700 DELTA FAIR BLVD	200 B	ANTIOCH	CA	94509	4019	00	06000	38.0038852	-121.8448833	Contra Costa County
336838	Ordering, Referring, Prescribing	N/A	1538316187	0	0	JAMES, GENIE M	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82918	N/A	N/A	N/A	N/A	N/A	658 E. BRIER DR.	250	SAN BERNARDINO	CA	92408	2875	00	06000	34.07137738	-117.2702805	San Bernardino County
336942	Ordering, Referring, Prescribing	N/A	1538496047	0	0	JAHDAI-BROWN, NYA DC	9/13/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC33121	N/A	N/A	N/A	N/A	N/A	2019 SATURN ST	None	MONTEREY	CA	91755	7415	00	06000	34.03842408	-118.1166973	Los Angeles County
337025	Ordering, Referring, Prescribing	N/A	1538613864	0	0	JACOBO-EVANS, MONIQUE LCSW	12/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127545	N/A	N/A	N/A	N/A	N/A	2005A VIA BARRETT	None	SAN LORENZO	CA	94580	1315	00	06000	37.67410639	-122.1502603	Alameda County
337172	Ordering, Referring, Prescribing	N/A	1548205719	0	0	JONES, MICHAEL A LCSW	3/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22452	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
337185	Ordering, Referring, Prescribing	N/A	1548261373	0	0	JOHNSON, GINA MD	8/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71252	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
337237	Ordering, Referring, Prescribing	N/A	1548399330	0	0	JONES, JULIE E LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40596	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD.	SUITE 200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
337270	Ordering, Referring, Prescribing	N/A	1548484496	0	0	JALLAD, CHRISTINA M LCSW	3/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61729	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	SUITE 100	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
337271	Ordering, Referring, Prescribing	N/A	1548464738	0	0	JAWICH, AMER	4/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56999	N/A	N/A	N/A	N/A	N/A	9902 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2801	00	06000	35.36882344	-119.1124447	Kern County
337272	Ordering, Referring, Prescribing	N/A	1548485659	0	0	JUAREZ, JOSEFINA V LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26171	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
337344	Ordering, Referring, Prescribing	N/A	1548620107	0	0	JOHNSTON, TARA M	9/7/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100418	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
337361	Ordering, Referring, Prescribing	N/A	1548646854	0	0	JOO, JASON I	1/28/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	D64895	N/A	N/A	N/A	N/A	N/A	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4238	00	06000	34.045119	-117.6464565	San Bernardino County
337447	Ordering, Referring, Prescribing	N/A	1548791155	0	0	JIMENEZ, JESSE LCSW	9/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110595	N/A	N/A	N/A	N/A	N/A	915 N MILPAS STREET	None	SANTA BARBARA	CA	93103	2331	00	06000	34.43040726	-119.6909855	Santa Barbara County
337455	Ordering, Referring, Prescribing	N/A	1548819113	0	0	JIMENEZ QUINTANILLA, KARLA PSYD	3/20/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34941	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
337488	Ordering, Referring, Prescribing	N/A	1548914013	0	0	JONES-UDEFI, DENETA M	5/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29795	N/A	N/A	N/A	N/A	N/A	430 RAILROAD AVE	207	PITTSBURG	CA	94565	0043	00	06000	38.03246265	-121.8837299	Contra Costa County
337546	Ordering, Referring, Prescribing	N/A	1558148353	0	0	JAIME LARA, BERTA CNP	9/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027177	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
337554	Ordering, Referring, Prescribing	N/A	1558335067	0	0	JOHNSON, ALISON PSYD	5/14/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18416	N/A	N/A	N/A	N/A	N/A	15210 PARTHENIA ST	None	NORTH HILLS	CA	91343	0000	00	06000	34.22817263	-118.4636408	Los Angeles County
337595	Ordering, Referring, Prescribing	N/A	1558480731	0	0	JUAREZ, JOSE J LMFT	6/7/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47346	N/A	N/A	N/A	N/A	N/A	1900 W OLIVE AVE	None	BURBANK	CA	91506	2438	00	06000	34.16549174	-118.3249735	Los Angeles County
337606	Ordering, Referring, Prescribing	N/A	1558499582	0	0	JACKSON, THURMAN LMFT	10/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142041	N/A	N/A	N/A	N/A	N/A	3875 S WESTERN AVE	None	LOS ANGELES	CA	90062	1105	00	06000	34.015149	-118.3089395	Los Angeles County
337671	Ordering, Referring, Prescribing	N/A	1558645242	0	0	JENSEN, ERIC J PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61201	N/A	N/A	N/A	N/A	N/A	41169 GOODWIN WAY	STE 110	MADERA	CA	93636	8766	00	06000	36.88577349	-119.800021	Madera County
337687	Ordering, Referring, Prescribing	N/A	1558679456	0	0	JACOBO, DARLINE G LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77013	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	SUITE 100	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
337729	Ordering, Referring, Prescribing	N/A	1558732107	0	0	JOSEPH, TRACIA R LCSW	6/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108760	N/A	N/A	N/A	N/A	N/A	3725 TAYLOR ROAD	None	LOOMIS	CA	95650	9283	00	06000	38.81963826	-121.1950015	Placer County
337740	Ordering, Referring, Prescribing	N/A	1558779678	0	0	JONES, CYNDI L PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69314	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
337762	Ordering, Referring, Prescribing	N/A	1558809608	0	0	JOHNSON, SHELLYATTA T LCSW	2/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99953	N/A	N/A	N/A	N/A	N/A	995 SPRUCE ST.	None	GRIDLEY	CA	95948	2128	00	06000	39.36551662	-121.6980315	Butte County
337797	Ordering, Referring, Prescribing	N/A	1558861658	0	0	JOHNSON, DARCIA D LPCC	12/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8951	N/A	N/A	N/A	N/A	N/A	42455 10TH ST	42455 10TH ST W	LANCASTER	CA	93534	7060	00	06000	34.65438079	-118.1478341	Los Angeles County
337860	Ordering, Referring, Prescribing	N/A	1558982512	0	0	JEONG, MATTHEW B MD	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190535	N/A	N/A	N/A	N/A	N/A	1250 6TH AVE	None	SAN DIEGO	CA	92101	4300	00	06000	32.71854144	-117.1593008	San Diego County
337873	Ordering, Referring, Prescribing	N/A	1568014181	0	0	JOHNSON, MICHAEL M LMFT	4/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132140	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
337877	Ordering, Referring, Prescribing	N/A	1568023596	0	0	JIMENEZ, NANCY LMFT	8/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141209	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LN	None	SAN DIEGO	CA	92173	1346	00	06000	32.5659146	-117.059667	San Diego County
337909	Ordering, Referring, Prescribing	N/A	1568099034	0	0	JAVED, KINAAN F DO	2/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20507	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	0000	00	06000	32.68067201	-117.0804893	San Diego County
338004	Ordering, Referring, Prescribing	N/A	1568567105	0	0	JAVEED, SURYABANU	4/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A56307	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
338007	Ordering, Referring, Prescribing	N/A	1568570018	0	0	JOHNSON, JACK LMFT	5/20/2016	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	24968	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVENUE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
338082	Ordering, Referring, Prescribing	N/A	1568730950	0	0	JOHN, OLUKEMI PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51981	N/A	N/A	N/A	N/A	N/A	2050 GLENOAKS BLVD	None	SAN FERNANDO	CA	91340	1625	00	06000	34.29901991	-118.4387726	Los Angeles County
338165	Ordering, Referring, Prescribing	N/A	1568848398	0	0	JUAREZ, LUIS A LCSW	7/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102354	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE.	2ND FLOOR	HUNTINGTON PARK	CA	90255	0000	00	06000	33.98356476	-118.2241387	Los Angeles County
338213	Ordering, Referring, Prescribing	N/A	1568898039	0	0	JOHNSON, APRIL V LCSW	11/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98625	N/A	N/A	N/A	N/A	N/A	2420 MARTIN RD	None	FAIRFIELD	CA	94534	8651	00	06000	38.27452806	-122.0511683	Solano County
338228	Ordering, Referring, Prescribing	N/A	1568933885	0	0	JEFFERSON, KENDALL	5/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014629	N/A	N/A	N/A	N/A	N/A	316 N. MAIN STREET	None	SALINAS	CA	93901	0000	00	06000	36.682749	-121.6533777	Monterey County
338244	Ordering, Referring, Prescribing	N/A	1568955862	0	0	JUAREZ, VICTORIA T LCSW	9/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110455	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE #200	None	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
338275	Ordering, Referring, Prescribing	N/A	1578010138	0	0	JACOBS, REBECCA LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95899	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
338326	Ordering, Referring, Prescribing	N/A	1578092367	0	0	JEON, HEE D MD	1/31/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169507	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
338371	Ordering, Referring, Prescribing	N/A	1578189429	0	0	JOSEPH, LAUREN M	6/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197067	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
338516	Ordering, Referring, Prescribing	N/A	1578744637	0	0	JONES, APRIL P LCSW	7/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22800	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
338601	Ordering, Referring, Prescribing	N/A	1578877338	0	0	JARVIE, KELLIE M LMFT	5/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80085	N/A	N/A	N/A	N/A	N/A	160 E. HOLT BLVD.	SUITE B	POMONA	CA	91767	5407	00	06000	34.06239649	-117.7489613	Los Angeles County
338676	Ordering, Referring, Prescribing	N/A	1578975637	0	0	JOSIC, TATJANA DO	6/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14286	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
338678	Ordering, Referring, Prescribing	N/A	1578980207	0	0	JAIME, ROCIO P LPCC	10/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC5922	N/A	N/A	N/A	N/A	N/A	17317 FREMONT STREET	None	ESPARTO	CA	95627	2137	00	06000	38.689866	-122.0184405	Yolo County
339070	Ordering, Referring, Prescribing	N/A	1588952667	0	0	JIMENEZ, JOHANNA S LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93146	N/A	N/A	N/A	N/A	N/A	2200 W ORANGEWOOD AVE	SUITE 212	ORANGE	CA	92868	1945	00	06000	33.79576054	-117.875655	Orange County
339072	Ordering, Referring, Prescribing	N/A	1588964381	0	0	JOHNSON, NANCY E PHARMD	7/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	47546	N/A	N/A	N/A	N/A	N/A	845 COLLEGE BLVD	None	OCEANSIDE	CA	92057	6258	00	06000	33.240771	-117.294741	San Diego County
339080	Ordering, Referring, Prescribing	N/A	1588967061	0	0	JAUREGUI, RACHEL A LCSW	12/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83389	N/A	N/A	N/A	N/A	N/A	215 E AVENIDA DE LA MERC	None	MONTEBELLO	CA	90640	2752	00	06000	34.02362048	-118.0947432	Los Angeles County
339162	Ordering, Referring, Prescribing	N/A	1598079956	0	0	JARRELL, TODD M MD	4/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C172395	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
339182	Ordering, Referring, Prescribing	N/A	1598126500	0	0	JETT, JIMMI MARIE M LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88672	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
339205	Ordering, Referring, Prescribing	N/A	1598143083	0	0	JAZAYERI, ALI PHD	12/8/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26476	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2501	00	06000	34.06170677	-118.302787	Los Angeles County
339233	Ordering, Referring, Prescribing	N/A	1598192668	0	0	JI, SHANSHAN	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62805	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
339363	Ordering, Referring, Prescribing	N/A	1598477358	0	0	JIMENEZ, CAROLINA CNP	5/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023502	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
339367	Ordering, Referring, Prescribing	N/A	1598499337	0	0	JACKSON, ERIN B	7/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021702	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
339444	Ordering, Referring, Prescribing	N/A	1598916017	0	0	JOHNSON, CHERYL F	12/14/2017	Taxonomy not applicable	NA	n/a	000	Unknown	112	N/A	N/A	N/A	N/A	N/A	10535 HOWARD ST	None	MENDOCINO	CA	95460	9781	00	06000	39.30767937	-123.7979123	Mendocino County
339448	Ordering, Referring, Prescribing	N/A	1598918575	0	0	JAYARAMAN, CAAITHIRY MD	1/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115944	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
339476	Ordering, Referring, Prescribing	N/A	1598971723	0	0	JORDAN, MICHAEL W MD	2/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A74227	N/A	N/A	N/A	N/A	N/A	313 S WATERMAN AVE	None	EL CENTRO	CA	92243	2215	00	06000	32.7904841	-115.574105	Imperial County
339494	Ordering, Referring, Prescribing	N/A	1609007509	0	0	JONES, BRITTANY PT	10/18/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	35840	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
339547	Ordering, Referring, Prescribing	N/A	1609142603	0	0	JACOB, NOAM MD	9/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131051	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
339579	Ordering, Referring, Prescribing	N/A	1609177641	0	0	JENKINS, CHARLOTTE NP	5/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95025124	N/A	N/A	N/A	N/A	N/A	3333 CONCOURS	4200	ONTARIO	CA	91764	4875	00	06000	34.0749	-117.5787495	San Bernardino County
339647	Ordering, Referring, Prescribing	N/A	1609301910	0	0	JONES, PHILLIP T	12/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007487	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
339657	Ordering, Referring, Prescribing	N/A	1609306331	0	0	JAMALL, SUNUM LMFT	5/7/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146780	N/A	N/A	N/A	N/A	N/A	516 GIBSON DR	STE 100	ROSEVILLE	CA	95678	5792	00	06000	38.77885319	-121.2746879	Placer County
339822	Ordering, Referring, Prescribing	N/A	1609907724	0	0	JAUREGUI, BELINDA H LCSW	4/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23048	N/A	N/A	N/A	N/A	N/A	17800 HWY. 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
339825	Ordering, Referring, Prescribing	N/A	1609903921	0	0	JOHNSON, SONIA LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23435	N/A	N/A	N/A	N/A	N/A	5150 E. PACIFIC COAST HI	STE. 100	LONG BEACH	CA	90804	0550	00	06000	33.7831762	-118.1333125	Los Angeles County
339834	Ordering, Referring, Prescribing	N/A	1609931484	0	0	JOTHI, SUMANA MD	10/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90856	N/A	N/A	N/A	N/A	N/A	1320 EL CAPITAN DR	STE 120	DANVILLE	CA	94526	0000	00	06000	37.78476866	-121.9658691	Contra Costa County
339845	Ordering, Referring, Prescribing	N/A	1609951029	0	0	JOE, LORAH L LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20242	N/A	N/A	N/A	N/A	N/A	225 W BROADWAY	#155	BURBANK	CA	91204	1332	00	06000	34.14673469	-118.257145	Los Angeles County
339856	Ordering, Referring, Prescribing	N/A	1609973510	0	0	JONES, MEGAN D LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49182	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
339915	Ordering, Referring, Prescribing	N/A	1619088952	0	0	JOYNER, ADRIANA M	7/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46651	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	2500	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
339944	Ordering, Referring, Prescribing	N/A	1619146503	0	0	JACOBSON, AMY A NP	3/15/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0604040	N/A	N/A	N/A	N/A	N/A	650 CHARLES E YOUNG DR S	AZ-125 CHS	LOS ANGELES	CA	90095	8347	00	06000	34.06693676	-118.4427104	Los Angeles County
339971	Ordering, Referring, Prescribing	N/A	1619199668	0	0	JOHNSON, ELIZABETH A	9/8/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D27530	N/A	N/A	N/A	N/A	N/A	11333 PROSPECT DR	None	JACKSON	CA	95642	9311	00	06000	38.3716103	-120.8004838	Amador County
340041	Ordering, Referring, Prescribing	N/A	1619331899	0	0	JALALIZADEH, BAYAN MD	9/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162884	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
340083	Ordering, Referring, Prescribing	N/A	1619378288	0	0	JONES-PIERCE, RAQUEL R LCSW	1/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99745	N/A	N/A	N/A	N/A	N/A	41002 COUNTY CENTER DR	320	TEMECULA	CA	92591	6051	00	06000	33.52762603	-117.1615428	Riverside County
340085	Ordering, Referring, Prescribing	N/A	1619378916	0	0	JOUKAR, PANIZ PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71305	N/A	N/A	N/A	N/A	N/A	PARKWAY DR	None	LA MESA	CA	91941	0000	00	06000	32.77443731	-117.0318054	San Diego County
340086	Ordering, Referring, Prescribing	N/A	1619381969	0	0	JULE-FROST, VIRGINIA R LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95729	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	None	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
340143	Ordering, Referring, Prescribing	N/A	1619484128	0	0	JEFFERSON, JESSICA LCSW	4/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101167	N/A	N/A	N/A	N/A	N/A	2750 E WASHINGTON BLVD.	240	PASADENA	CA	91107	1448	00	06000	34.1680038	-118.0943955	Los Angeles County
340153	Ordering, Referring, Prescribing	N/A	1619504107	0	0	JONGSMA, RACHAEL L PHARMD	10/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82841	N/A	N/A	N/A	N/A	N/A	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	00	06000	35.39744148	-118.9822815	Kern County
340316	Ordering, Referring, Prescribing	N/A	1629188438	0	0	JUNG, KEVIN C DC	5/18/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	25721	N/A	N/A	N/A	N/A	N/A	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	00	06000	33.8698947	-117.9872467	Orange County
340334	Ordering, Referring, Prescribing	N/A	1629244553	0	0	JAMO RA, CHRISTINA Y PHD	1/22/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21943	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
340336	Ordering, Referring, Prescribing	N/A	1629245246	0	0	JONES, SHEQUITA S LCSW	5/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76045	N/A	N/A	N/A	N/A	N/A	2005B VIA BARRETT	None	SAN LORENZO	CA	94580	1315	00	06000	37.67413308	-122.1501285	Alameda County
340357	Ordering, Referring, Prescribing	N/A	1629294566	0	0	JESTER, LESLIE A NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0389959	N/A	N/A	N/A	N/A	N/A	7526 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92111	1504	00	06000	32.83275147	-117.157122	San Diego County
340450	Ordering, Referring, Prescribing	N/A	1629442058	0	0	JONES, STORMECA LMFT	11/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138717	N/A	N/A	N/A	N/A	N/A	1000 HILLVIEW CT	None	MILPITAS	CA	95035	4578	00	06000	37.4355681	-121.8918007	Santa Clara County
340482	Ordering, Referring, Prescribing	N/A	1629493200	0	0	JOUNG, JUN K LAC	7/11/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	4907	N/A	N/A	N/A	N/A	N/A	815 S ARDMORE AVE 1ST FL	None	LOS ANGELES	CA	90005	2597	00	06000	34.05717	-118.3020395	Los Angeles County
340548	Ordering, Referring, Prescribing	N/A	1629600705	0	0	JAY, SAMANTHA E PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81841	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
340564	Ordering, Referring, Prescribing	N/A	1629624044	0	0	JOHNSTON, KERI L	8/20/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	3704	N/A	N/A	N/A	N/A	N/A	435 6TH ST	None	WOODLAND	CA	95695	4109	00	06000	38.67611288	-121.7671382	Yolo County
340581	Ordering, Referring, Prescribing	N/A	1629643002	0	0	JENSEN, ALLISON	12/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143294	N/A	N/A	N/A	N/A	N/A	230 N MORRISON AVE	None	SAN JOSE	CA	95126	2741	00	06000	37.33307626	-121.9084647	Santa Clara County
340605	Ordering, Referring, Prescribing	N/A	1629690334	0	0	JONES, CARRISSA M LMFT	10/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150762	N/A	N/A	N/A	N/A	N/A	3680 E IMPERIAL HWY	SUITE 220	LYNWOOD	CA	90262	2659	00	06000	33.93211641	-118.2011728	Los Angeles County
340643	Ordering, Referring, Prescribing	N/A	1639136534	0	0	JOHNSON, THOMAS M MD	10/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G81064	N/A	N/A	N/A	N/A	N/A	8575 MORRO RD	K	ATASCEDERO	CA	93422	3991	00	06000	35.47073106	-120.6693149	San Luis Obispo County
340660	Ordering, Referring, Prescribing	N/A	1639206527	0	0	JACKSON, DONETTA LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38712	N/A	N/A	N/A	N/A	N/A	6130 VINELAND AVE.	None	NORTH HOLLYWOOD	CA	91601	3313	00	06000	34.18221147	-118.370279	Los Angeles County
340667	Ordering, Referring, Prescribing	N/A	1639222672	0	0	JAIN, ASHIKA MD	9/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C198978	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
340832	Ordering, Referring, Prescribing	N/A	1639531965	0	0	JOHNSON, STEPHANIE PSYD	1/7/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30152	N/A	N/A	N/A	N/A	N/A	500 EAST E ST.	STE#111	ONTARIO	CA	91764	0000	00	06000	34.068114	-117.6458355	San Bernardino County
340854	Ordering, Referring, Prescribing	N/A	1639565690	0	0	JASKOWIAK, WENDY C LMFT	8/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115786	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
340924	Ordering, Referring, Prescribing	N/A	1639663248	0	0	JOHAL, AMANDEEP K NP	8/6/2017	Taxonomy not applicable	NA	n/a	000	Unknown	559794	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
340927	Ordering, Referring, Prescribing	N/A	1639667397	0	0	JONES, KAMAAL MD	12/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165152	N/A	N/A	N/A	N/A	N/A	335 E. AVENUE I	12	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
340950	Ordering, Referring, Prescribing	N/A	1639691579	0	0	JANG, JEEHOON MD	7/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173800	N/A	N/A	N/A	N/A	N/A	15095 AMARGOSA RD	BLDG 1 SUIT 101	VICTORVILLE	CA	92394	1879	00	06000	34.52479785	-117.3303132	San Bernardino County
340994	Ordering, Referring, Prescribing	N/A	1639836208	0	0	JORDAN-MADRIGAL, TANYX LCSW	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124839	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
341001	Ordering, Referring, Prescribing	N/A	1639842115	0	0	JACQUES, ANGELICA CCC-SLP	1/25/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	30982	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE STREET	A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
341005	Ordering, Referring, Prescribing	N/A	1639857543	0	0	JACKMAN, TAYLOR E LPCC	6/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14122	N/A	N/A	N/A	N/A	N/A	818 N MOUNTAIN AVE	#219	SAN BERNARDINO	CA	91786	4167	00	06000	34.10424442	-117.6701797	San Bernardino
341075	Ordering, Referring, Prescribing	N/A	1649315854	0	0	JURKOVICH, JESSICA L LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98128	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
341208	Ordering, Referring, Prescribing	N/A	1649594417	0	0	JONES, CHRISTOPHER L MD FACOG	11/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120047	N/A	N/A	N/A	N/A	N/A	3209 N CALIFORNIA ST	None	STOCKTON	CA	95204	3448	00	06000	37.9810501	-121.2933517	San Joaquin County
341216	Ordering, Referring, Prescribing	N/A	1649603994	0	0	JIMENEZ STARETORP, MELISSA I LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93350	N/A	N/A	N/A	N/A	N/A	1270 NATIVIDAD RD	None	SALINAS	CA	93906	3144	00	06000	36.69733474	-121.6370383	Monterey County
341230	Ordering, Referring, Prescribing	N/A	1649622507	0	0	JAN, KIMLOAN PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68993	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
341244	Ordering, Referring, Prescribing	N/A	1649636432	0	0	JOLLY, CATHERINE LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44988	N/A	N/A	N/A	N/A	N/A	311 CALIFORNIA ST.	750	SAN FRANCISCO	CA	94104	2602	00	06000	37.79316768	-122.4002529	San Francisco County
341258	Ordering, Referring, Prescribing	N/A	1649654005	0	0	JONES, ANDREA L LMFT	3/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83633	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
341305	Ordering, Referring, Prescribing	N/A	1649747056	0	0	JEROME, MONICA L RN PHN	6/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	775702	N/A	N/A	N/A	N/A	N/A	1102 5TH STREET	None	WASCO	CA	93280	1338	00	06000	35.59698742	-119.3384925	Kern County
341323	Ordering, Referring, Prescribing	N/A	1649776899	0	0	JOHNSON, AXELINE J MD	5/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179054	N/A	N/A	N/A	N/A	N/A	4371 LATHAM ST	STE 200	RIVERSIDE	CA	92501	1706	00	06000	34.00254078	-117.375234	Riverside County
341361	Ordering, Referring, Prescribing	N/A	1649838582	0	0	JIMENEZ, JUAN R PHARMD	9/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48063	N/A	N/A	N/A	N/A	N/A	3010 N DEMAREE ST	None	VISALIA	CA	93291	7147	00	06000	36.357075	-119.331513	Tulare County
341391	Ordering, Referring, Prescribing	N/A	1649908518	0	0	JANI-HOANG, VANNA NP	10/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021961	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
341509	Ordering, Referring, Prescribing	N/A	1659460814	0	0	JACKSON, GRACE E MD	7/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C56001	N/A	N/A	N/A	N/A	N/A	145 CARSON VW	110	MARKLEEVILLE	CA	96120	9636	00	06000	38.80664209	-119.8025457	Alpine County
341529	Ordering, Referring, Prescribing	N/A	1659498319	0	0	JACOBSEN, PATRICIA K LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38463	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
341571	Ordering, Referring, Prescribing	N/A	1659581668	0	0	JENNINGS-PARRIOTT, KARI A	4/23/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61381	N/A	N/A	N/A	N/A	N/A	386 14TH STREET	None	OAKLAND	CA	94612	3211	00	06000	37.80371572	-122.2696209	Alameda County
341579	Ordering, Referring, Prescribing	N/A	1659597615	0	0	JOHNSON, DEBORAH K	5/13/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0262776	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
341731	Ordering, Referring, Prescribing	N/A	1659825750	0	0	JORDAN, XONIELLE LCSW	9/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96918	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
341754	Ordering, Referring, Prescribing	N/A	1659857654	0	0	JOHNSON, ABIMBOLA DPM	7/14/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5744	N/A	N/A	N/A	N/A	N/A	1919 STATE ST	206	SANTA BARBARA	CA	93101	2430	00	06000	34.4306401	-119.7144766	Santa Barbara County
341796	Ordering, Referring, Prescribing	N/A	1659952414	0	0	JONES, ZOE LCSW	9/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110569	N/A	N/A	N/A	N/A	N/A	365 KUCK LN	None	PETALUMA	CA	94952	9606	00	06000	38.25757751	-122.7132072	Sonoma County
341807	Ordering, Referring, Prescribing	N/A	1659982908	0	0	JE, ROBIN DMD	7/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110275	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
341888	Ordering, Referring, Prescribing	N/A	1669226478	0	0	JUNG, JIN GYO NP	4/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029707	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
341962	Ordering, Referring, Prescribing	N/A	1669621371	0	0	JEE, CHRISTINA S NP	7/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18192	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
341972	Ordering, Referring, Prescribing	N/A	1669643557	0	0	JANEWAY, REBECCA LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	54054	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
341999	Ordering, Referring, Prescribing	N/A	1669721700	0	0	JUNG, MINA M NP	7/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23192	N/A	N/A	N/A	N/A	N/A	151 KAMLUS DRIVE	K2	COSTA MESA	CA	92626	5919	00	06000	33.67282141	-117.8824994	Orange County
342003	Ordering, Referring, Prescribing	N/A	1669722146	0	0	JUAREZ, ANGELICA MSW LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83058	N/A	N/A	N/A	N/A	N/A	600 G ST	None	UNION CITY	CA	94587	2400	00	06000	37.59996226	-122.0201927	Alameda County
342008	Ordering, Referring, Prescribing	N/A	1669737557	0	0	JOHNSON, GRAHAM K DO	11/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12961	N/A	N/A	N/A	N/A	N/A	2019 WEBSTER ST	None	SAN FRANCISCO	CA	94115	2329	00	06000	37.78976076	-122.4323529	San Francisco County
342056	Ordering, Referring, Prescribing	N/A	1669827200	0	0	JONES, KELLY MD	10/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151821	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
342058	Ordering, Referring, Prescribing	N/A	1669822409	0	0	JENKINS, ALESE LCSW	8/17/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27237	N/A	N/A	N/A	N/A	N/A	2240 OLD RIVER RD	None	UKIAH	CA	95482	6103	00	06000	39.1293897	-123.1645436	Mendocino County
342091	Ordering, Referring, Prescribing	N/A	1669898037	0	0	JONES, JOSEPH J LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51233	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
342120	Ordering, Referring, Prescribing	N/A	1669945705	0	0	JAMES, ANDREA D NP	4/8/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010790	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
342397	Ordering, Referring, Prescribing	N/A	1679771174	0	0	JOHNSON, MALIA L	11/25/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D54498	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
342537	Ordering, Referring, Prescribing	N/A	1689019853	0	0	JOLLEY, MARGARET A MD	1/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A136179	N/A	N/A	N/A	N/A	N/A	498 MAIN ST	None	TULELAKE	CA	96134	9411	00	06000	41.95501066	-121.4767132	Siskiyou County
342540	Ordering, Referring, Prescribing	N/A	1689022907	0	0	JUNG, JEEYOON MD	2/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A151445	N/A	N/A	N/A	N/A	N/A	268 W HOSPITALITY LN	FOURTH FLOOR	SAN BERNARDINO	CA	92408	3241	00	06000	34.06596535	-117.2890969	San Bernardino County
342589	Ordering, Referring, Prescribing	N/A	1689095416	0	0	JONES, LAKERA S CNP	3/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95002822	N/A	N/A	N/A	N/A	N/A	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
342648	Ordering, Referring, Prescribing	N/A	1689192049	0	0	JOHNS, JAMESINA NP	6/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008019	N/A	N/A	N/A	N/A	N/A	1001 E COOLEY DR	107	COLTON	CA	92324	3941	00	06000	34.0546353	-117.3110923	San Bernardino County
342701	Ordering, Referring, Prescribing	N/A	1689291056	0	0	JANG, KATIE OD	6/29/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34556	N/A	N/A	N/A	N/A	N/A	21739 S AVALON BLVD	None	CARSON	CA	90745	3302	00	06000	33.830361	-118.263757	Los Angeles County
342747	Ordering, Referring, Prescribing	N/A	1689645525	0	0	JOHNSON, CHRISTINE L MD FAAP	7/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C134838	N/A	N/A	N/A	N/A	N/A	34800 BOB WILSON DR	None	SAN DIEGO	CA	92134	1098	00	06000	32.724567	-117.145467	San Diego County
342886	Ordering, Referring, Prescribing	N/A	1689963548	0	0	JAMI, FEROOZAN	6/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104002	N/A	N/A	N/A	N/A	N/A	275 E BAKER ST	SUITE A	COSTA MESA	CA	92626	4566	00	06000	33.67816303	-117.8764512	Orange County
342887	Ordering, Referring, Prescribing	N/A	1689963563	0	0	JACKSON, LAUREN A	1/5/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	21260	N/A	N/A	N/A	N/A	N/A	1515 SPRINGFIELD DR	175	CHICO	CA	95928	5995	00	06000	39.73096434	-121.8089646	Butte County
342994	Ordering, Referring, Prescribing	N/A	1699157529	0	0	JOHNSON, MARIE E PSYD	1/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29577	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
343178	Ordering, Referring, Prescribing	N/A	1699747808	0	0	JACOBS, MARGARET PA-C	2/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	14787	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
343204	Ordering, Referring, Prescribing	N/A	1699810408	0	0	JANSEN, WOUTER N LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26844	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
343228	Ordering, Referring, Prescribing	N/A	1699846642	0	0	JAMES, ADELENE R MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C38435	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
343342	Ordering, Referring, Prescribing	N/A	1700128378	0	0	JOHNSON-STEMEN, TERRI L LCSW	6/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101890	N/A	N/A	N/A	N/A	N/A	260 COHASSET ROAD	STE 120 & 130	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
343362	Ordering, Referring, Prescribing	N/A	1700159373	0	0	JENSEN, LISA A CNM	7/22/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW1984	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
343415	Ordering, Referring, Prescribing	N/A	1700230521	0	0	JIANG, YANG MD	7/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161229	N/A	N/A	N/A	N/A	N/A	4867 SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	00	06000	34.0981755	-118.295055	Los Angeles County
343440	Ordering, Referring, Prescribing	N/A	1700260015	0	0	JASON, ROBERT A DO	12/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	5101022094	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
343460	Ordering, Referring, Prescribing	N/A	1700306511	0	0	JOHNSON, WHITNEY D LCSW	7/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102616	N/A	N/A	N/A	N/A	N/A	3711 LONG BEACH BLVD	SUITE 4057 4TH FLOOR #10	LONG BEACH	CA	90807	3315	00	06000	33.824583	-118.1893785	Los Angeles County
343511	Ordering, Referring, Prescribing	N/A	1700372760	0	0	JOHAL, JANINE PA-C	2/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	55652	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
343686	Ordering, Referring, Prescribing	N/A	1710003744	0	0	JOHNSON, LINDA LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43800	N/A	N/A	N/A	N/A	N/A	222 PAUL SCANNELL DRIVE	None	SAN MATEO	CA	94401	4061	00	06000	37.51168342	-122.3375282	San Mateo County
343730	Ordering, Referring, Prescribing	N/A	1710097621	0	0	JAVANBAKHT, ALI MD	7/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70993	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
343735	Ordering, Referring, Prescribing	N/A	1710124722	0	0	JUDGE, CLAIRE M LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65015	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
343755	Ordering, Referring, Prescribing	N/A	1710171970	0	0	JOY, MICHAEL R LMFT	9/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53563	N/A	N/A	N/A	N/A	N/A	2617 K ST	#200	SACRAMENTO	CA	95816	5116	00	06000	38.573595	-121.4715825	Sacramento County
343768	Ordering, Referring, Prescribing	N/A	1710194212	0	0	JUNG, DENNA S RN CPNP	2/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	388474	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
343865	Ordering, Referring, Prescribing	N/A	1710347133	0	0	JOYCE, LENNIS NP	12/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003089	N/A	N/A	N/A	N/A	N/A	12855 RUNWAY RD	3316	PLAYA VISTA	CA	90094	2699	00	06000	33.97550094	-118.4193589	Los Angeles County
343913	Ordering, Referring, Prescribing	N/A	1710413208	0	0	JOHNSON WHITE, JHAUREL NP	9/26/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010523	N/A	N/A	N/A	N/A	N/A	1510 S. CENTRAL AVE	600	GLENDALE	CA	91204	2548	00	06000	34.12709764	-118.2577911	Los Angeles County
343918	Ordering, Referring, Prescribing	N/A	1710426077	0	0	JANUSKA, HYE-UN PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42869	N/A	N/A	N/A	N/A	N/A	481 S VENTURA RD	None	OXNARD	CA	93030	6550	00	06000	34.19848342	-119.1948902	Ventura County
343921	Ordering, Referring, Prescribing	N/A	1710431648	0	0	JACOB-OVIATT, GLENN	2/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103743	N/A	N/A	N/A	N/A	N/A	1922 THE ALAMEDA	None	SAN JOSE	CA	95126	1457	00	06000	37.34128547	-121.9236047	Santa Clara County
343967	Ordering, Referring, Prescribing	N/A	1710510672	0	0	JUNG, YOUNG PHARMD	11/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81822	N/A	N/A	N/A	N/A	N/A	927 S CHINA LAKE BLVD	None	RIDGECREST	CA	93555	6315	00	06000	35.60444344	-117.6740966	Kern County
343983	Ordering, Referring, Prescribing	N/A	1710537618	0	0	JAMES, KARA NP	11/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	F09181412	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BOULEVAR	300	LAWNDALE	CA	91026	0000	00	06000	33.898572	-118.3527775	Los Angeles County
344006	Ordering, Referring, Prescribing	N/A	1710629449	0	0	JUNG, DANIELLE	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189744	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
344024	Ordering, Referring, Prescribing	N/A	1710663562	0	0	JANDU, PARMINDER K NP	5/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025139	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
344044	Ordering, Referring, Prescribing	N/A	1710969191	0	0	JOHNSON, JENNA G PSYD	12/27/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18496	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
344090	Ordering, Referring, Prescribing	N/A	1720126907	0	0	JEDZINAK, JULIE A PSYD	8/5/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22990	N/A	N/A	N/A	N/A	N/A	2460 CLAY BANK RD	BUILDING 8	FAIRFIELD	CA	94533	1655	00	06000	38.274507	-122.0064875	Solano County
344105	Ordering, Referring, Prescribing	N/A	1720163595	0	0	JORDAN, ADRIENNE A LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28898	N/A	N/A	N/A	N/A	N/A	3075 MYERS ST	None	RIVERSIDE	CA	92503	5525	00	06000	33.90872869	-117.4423238	Riverside County
344154	Ordering, Referring, Prescribing	N/A	1720266760	0	0	JAHANGIRI, MOHAMMAD I	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A56400	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
344229	Ordering, Referring, Prescribing	N/A	1720387301	0	0	JIMENEZ-SNOW, LINDA C PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	39789	N/A	N/A	N/A	N/A	N/A	24160 LYONS AVE	None	NEWHALL	CA	91321	2442	00	06000	34.37872109	-118.5572162	Los Angeles County
344289	Ordering, Referring, Prescribing	N/A	1720455066	0	0	JENSEN, BRENT PT	9/12/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	42896	N/A	N/A	N/A	N/A	N/A	820 E. ENOS DR.	None	SANTA MARIA	CA	93454	7295	00	06000	34.93441847	-120.42207	Santa Barbara County
344308	Ordering, Referring, Prescribing	N/A	1720474281	0	0	JAWAD, SADEED MD	3/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163296	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
344356	Ordering, Referring, Prescribing	N/A	1720546484	0	0	JOHNSON, NATALIE S RN PHN	1/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	95035678	N/A	N/A	N/A	N/A	N/A	1000 YULUPA AVE	None	SANTA ROSA	CA	95405	7020	00	06000	38.444121	-122.6741175	Sonoma County
344487	Ordering, Referring, Prescribing	N/A	1730114067	0	0	JACOBS, THOMAS A DPM	1/19/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	4587	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
344525	Ordering, Referring, Prescribing	N/A	1730227935	0	0	JENNINGS, DAWN G LMFT	8/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46720	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER COURT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
344528	Ordering, Referring, Prescribing	N/A	1730225970	0	0	JORTH, NANCY L LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39458	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	None	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
344555	Ordering, Referring, Prescribing	N/A	1730268327	0	0	JIMENO, ROSANNA M PSYD	10/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22591	N/A	N/A	N/A	N/A	N/A	429 N. SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1399	00	06000	34.44573228	-119.7804008	Santa Barbara County
344570	Ordering, Referring, Prescribing	N/A	1730317751	0	0	JIRAJARIYAVEJ, TEERANUN MD	9/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118478	N/A	N/A	N/A	N/A	N/A	4755 NEXUS CENTER DR	None	SAN DIEGO	CA	92121	3051	00	06000	32.87858497	-117.2037598	San Diego County
344671	Ordering, Referring, Prescribing	N/A	1730526930	0	0	JONES, JENNIFER R	4/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50737	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
344765	Ordering, Referring, Prescribing	N/A	1730686171	0	0	JONES, MIARAH LCSW	7/23/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124471	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	1500	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
344769	Ordering, Referring, Prescribing	N/A	1730692690	0	0	JIMENEZ, MARLENE LMFT	5/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126171	N/A	N/A	N/A	N/A	N/A	2719 N. AIR FRESNO DR.	None	FRESNO	CA	93727	1547	00	06000	36.77448139	-119.7281325	Fresno County
344817	Ordering, Referring, Prescribing	N/A	1730775933	0	0	JOHNSON, EVAN PA-C	5/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61112	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
344860	Ordering, Referring, Prescribing	N/A	1730956871	0	0	JOHNSON, ANN JONALYN NP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025896	N/A	N/A	N/A	N/A	N/A	4900 CALIFORNIA AVE	100B	BAKERSFIELD	CA	93309	7081	00	06000	35.36440586	-119.0562732	Kern County
344884	Ordering, Referring, Prescribing	N/A	1740259027	0	0	JONES JR, JULIUS R	1/3/1996	Taxonomy not applicable	NA	n/a	099	DENTIST	D40839	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
344945	Ordering, Referring, Prescribing	N/A	1740411214	0	0	JACKSON, AJANI D MD	11/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131170	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	None	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
344970	Ordering, Referring, Prescribing	N/A	1740470319	0	0	JAVDAN, SEAN MD	7/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A108346	N/A	N/A	N/A	N/A	N/A	1711 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	4901	00	06000	34.0127217	-118.466458	Los Angeles County
345155	Ordering, Referring, Prescribing	N/A	1740785245	0	0	JOHNS, ALEXANDRA MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	164521	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
345203	Ordering, Referring, Prescribing	N/A	1740863828	0	0	JEONG, MOONSUN NP	5/18/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017339	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
345291	Ordering, Referring, Prescribing	N/A	1750388716	0	0	JOHNSON, LISA M CNP	11/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	492768	N/A	N/A	N/A	N/A	N/A	8043 2ND ST	105	DOWNEY	CA	90241	3621	00	06000	33.94296553	-118.1360957	Los Angeles County
345347	Ordering, Referring, Prescribing	N/A	1750486189	0	0	JAIN, SHARAD MD	10/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G78997	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
345351	Ordering, Referring, Prescribing	N/A	1750501821	0	0	JONES, ELIZABETH V LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24488	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	200	CONCORD	CA	94520	5223	00	06000	37.98393807	-122.0466953	Contra Costa County
345382	Ordering, Referring, Prescribing	N/A	1750583043	0	0	JONES, LAUREN E LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52365	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	200	VAN NUYS	CA	91405	5850	00	06000	34.20025916	-118.4500763	Los Angeles County
345412	Ordering, Referring, Prescribing	N/A	1750662854	0	0	JAKOBSON, HARRY C LCSW	3/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72495	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
345449	Ordering, Referring, Prescribing	N/A	1750718540	0	0	JOHNSON, EMILY N MSW LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81731	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	MS 10-100	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
345468	Ordering, Referring, Prescribing	N/A	1750741062	0	0	JIMENEZ, HEATHER NP	1/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012525	N/A	N/A	N/A	N/A	N/A	3112 N 80TH PL	None	SCOTTSDALE	AZ	85251	6602	00	06000	33.48369	-111.907233	Maricopa County
345540	Ordering, Referring, Prescribing	N/A	1750853347	0	0	JACKSON, ANT'QUINETTE NP	12/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010731	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	SUITE 300	LAWNDALE	CA	90260	1581	00	06000	33.898572	-118.3527775	Los Angeles County
345562	Ordering, Referring, Prescribing	N/A	1750884987	0	0	JACOBSON, CHRISTOPHER J PHARMD	9/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73472	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
345599	Ordering, Referring, Prescribing	N/A	1750943171	0	0	JOHNSON, BRIDGET E NP	10/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	523296	N/A	N/A	N/A	N/A	N/A	621 N STATE ST	None	SAN JACINTO	CA	92583	6568	00	06000	33.79501272	-116.9715035	Riverside County
345610	Ordering, Referring, Prescribing	N/A	1750998969	0	0	JACQUES, CHRISTIE M	4/8/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105393	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
345622	Ordering, Referring, Prescribing	N/A	1760010102	0	0	JHIN, ALLISON M DO	7/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21542	N/A	N/A	N/A	N/A	N/A	711 STONY POINT RD	17	SANTA ROSA	CA	95407	6802	00	06000	38.428848	-122.7420045	Sonoma County
345703	Ordering, Referring, Prescribing	N/A	1760440267	0	0	JANNE D'OTHEE, BERTRAND MD	1/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53060	N/A	N/A	N/A	N/A	N/A	71780 SAN JACINTO DR	BUILDING I	RANCHO MIRAGE	CA	92270	5516	00	06000	33.74325198	-116.411769	Riverside County
345848	Ordering, Referring, Prescribing	N/A	1760768352	0	0	JIANG, YASHU LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82575	N/A	N/A	N/A	N/A	N/A	1990 41ST AVE	None	SAN FRANCISCO	CA	94116	1101	00	06000	37.74984135	-122.4997872	San Francisco County
345971	Ordering, Referring, Prescribing	N/A	1760943187	0	0	JI, OK DO	12/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20531	N/A	N/A	N/A	N/A	N/A	3 CORPORATE PARK	SUITE 170	IRVINE	CA	92606	5111	00	06000	33.69055394	-117.8260389	Orange County
346022	Ordering, Referring, Prescribing	N/A	1770037541	0	0	JIRIES, JENNIFER LCSW	7/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98136	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
346049	Ordering, Referring, Prescribing	N/A	1770082141	0	0	JASANI, RAJNIS V	10/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	50638	N/A	N/A	N/A	N/A	N/A	8237 ROCHESTER AVE	SUITE 140	RANCHO CUCAMONGA	CA	91730	0000	00	06000	34.103952	-117.5435325	San Bernardino County
346061	Ordering, Referring, Prescribing	N/A	1770124497	0	0	JOHNSON, ELISHA J LMFT	11/21/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151530	N/A	N/A	N/A	N/A	N/A	525 W AVE P-4	None	PALMDALE	CA	93551	0000	00	06000	34.6018893	-118.1385842	Los Angeles County
346071	Ordering, Referring, Prescribing	N/A	1770141210	0	0	JUTEAU, JULI A LMFT	3/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112351	N/A	N/A	N/A	N/A	N/A	2001 S BARRINGTON AVE	215	LOS ANGELES	CA	90025	5363	00	06000	34.03672191	-118.4500156	Los Angeles County
346115	Ordering, Referring, Prescribing	N/A	1770259426	0	0	JENSEN, JESSICA L PSYD	3/20/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34090	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	None	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
346161	Ordering, Referring, Prescribing	N/A	1770624009	0	0	JOHNSON, DEBORAH A	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48125	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
346166	Ordering, Referring, Prescribing	N/A	1770629545	0	0	JENKINS, TONYA LMFT	3/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138671	N/A	N/A	N/A	N/A	N/A	7986 DAGGET ST	None	SAN DIEGO	CA	92111	2321	00	06000	32.82363345	-117.1512855	San Diego County
346193	Ordering, Referring, Prescribing	N/A	1770709909	0	0	JONES, KENDALL E LCSW	10/16/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74812	N/A	N/A	N/A	N/A	N/A	912 FREMONT STREET	None	DELANO	CA	93215	2713	00	06000	35.76763031	-119.2498143	Kern County
346203	Ordering, Referring, Prescribing	N/A	1770732000	0	0	JUAREZ, NATALIE R LCSW	9/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65901	N/A	N/A	N/A	N/A	N/A	11627 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4911	00	06000	33.93480209	-118.1323324	Los Angeles County
346268	Ordering, Referring, Prescribing	N/A	1770867822	0	0	JUN, DANIEL S	10/19/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D60843	N/A	N/A	N/A	N/A	N/A	2138 DEL PASO BLVD	None	SACRAMENTO	CA	95815	3002	00	06000	38.609811	-121.4510265	Sacramento County
346300	Ordering, Referring, Prescribing	N/A	1770911745	0	0	JORDAN, LYNN M NP	5/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	696262	N/A	N/A	N/A	N/A	N/A	21337 BUSH ST	None	MIDDLETOWN	CA	95461	0000	00	06000	38.74858031	-122.6176566	Lake County
346309	Ordering, Referring, Prescribing	N/A	1770930034	0	0	JIMENEZ, DANIELLE LMFT	10/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122711	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
346326	Ordering, Referring, Prescribing	N/A	1770954414	0	0	JOHANSEN, WENDY S	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110897	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
346425	Ordering, Referring, Prescribing	N/A	1780105692	0	0	JANVELIAN, VLADIMIR MD	12/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166669	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
346432	Ordering, Referring, Prescribing	N/A	1780110338	0	0	JOO, WOOJIN	3/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160312	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
346519	Ordering, Referring, Prescribing	N/A	1780302711	0	0	JOHNSON, KARRYLEE M NP	7/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021621	N/A	N/A	N/A	N/A	N/A	9128 WOODMAN AVE	None	ARLETA	CA	91331	6405	00	06000	34.23612313	-118.4409578	Los Angeles County
346520	Ordering, Referring, Prescribing	N/A	1780298695	0	0	JANKAEW, JACQUELINE NP	11/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014608	N/A	N/A	N/A	N/A	N/A	420 S. GLENDORA AVENUE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
346535	Ordering, Referring, Prescribing	N/A	1780347716	0	0	JONES, SHELBY PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85412	N/A	N/A	N/A	N/A	N/A	725 CENTER DR	None	SAN MARCOS	CA	92069	3536	00	06000	33.13491593	-117.1248872	San Diego County
346639	Ordering, Referring, Prescribing	N/A	1780818971	0	0	JAWAD, YOUSIF PA	4/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA20303	N/A	N/A	N/A	N/A	N/A	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	00	06000	33.93782301	-118.1288691	Los Angeles County
346658	Ordering, Referring, Prescribing	N/A	1780867101	0	0	JACKSON, SARAH M LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85947	N/A	N/A	N/A	N/A	N/A	395 TAYLOR BLVD.	200	PLEASANT HILL	CA	94523	0165	00	06000	37.96119614	-122.070409	Contra Costa County
346684	Ordering, Referring, Prescribing	N/A	1780919282	0	0	JOHNSON, WALTER K MD	4/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G32232	N/A	N/A	N/A	N/A	N/A	12140 NEW YORK RANCH RD	None	JACKSON	CA	95642	9407	00	06000	38.38465694	-120.739897	Amador County
346744	Ordering, Referring, Prescribing	N/A	1790019958	0	0	JARDINA, SHANNON L	5/21/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D58569	N/A	N/A	N/A	N/A	N/A	201 S HARBOR BLVD	None	LA HABRA	CA	90631	5654	00	06000	33.93029897	-117.9331306	Orange County
346759	Ordering, Referring, Prescribing	N/A	1790055085	0	0	JIMENEZ TIJERINO, ANIELKHA M LCSW	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96417	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
346908	Ordering, Referring, Prescribing	N/A	1790251247	0	0	JARMON-FLORES, TANISHA LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109226	N/A	N/A	N/A	N/A	N/A	222 E MAIN ST	117	BARSTOW	CA	92311	2361	00	06000	34.89870403	-117.025149	San Bernardino County
346926	Ordering, Referring, Prescribing	N/A	1790281525	0	0	JENKINS, CHRISTOPHER S MD	6/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197076	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
346977	Ordering, Referring, Prescribing	N/A	1790365120	0	0	JUDGE, GEORNICE NP	4/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16438	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY	None	LOS ANGELES	CA	90003	3335	00	06000	33.96110579	-118.2782667	Los Angeles County
347003	Ordering, Referring, Prescribing	N/A	1790450906	0	0	JABUSCH, TAYLOR PA	10/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60295	N/A	N/A	N/A	N/A	N/A	3111 PROFESSIONAL DRIVE	None	AUBURN	CA	95603	2456	00	06000	38.940327	-121.1007585	Placer County
347017	Ordering, Referring, Prescribing	N/A	1790501682	0	0	JEE, JACQUELYN PHARMD	2/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	87699	N/A	N/A	N/A	N/A	N/A	3257 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5220	00	06000	38.567835	-121.4643735	Sacramento County
347047	Ordering, Referring, Prescribing	N/A	1790808400	0	0	JAMES, MARSTON LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35270	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
347052	Ordering, Referring, Prescribing	N/A	1790810554	0	0	JARQUIN, LUIS O LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41743	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
347110	Ordering, Referring, Prescribing	N/A	1790933398	0	0	JONES, VALORIA D LCSW	10/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW67192	N/A	N/A	N/A	N/A	N/A	2045 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5626	00	06000	33.76536396	-116.9587092	Riverside County
347130	Ordering, Referring, Prescribing	N/A	1790977502	0	0	JOHNSON, STACI R MD	9/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85895	N/A	N/A	N/A	N/A	N/A	14071 PEYTON DR	3010	CHINO HILLS	CA	91709	7241	00	06000	33.99919939	-117.7325814	San Bernardino County
347260	Ordering, Referring, Prescribing	N/A	1801196308	0	0	JOHNS, JILL PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54613	N/A	N/A	N/A	N/A	N/A	2207 FRANCISCO DR	None	EL DORADO HILLS	CA	95762	0000	00	06000	38.71116945	-121.0856711	El Dorado County
347263	Ordering, Referring, Prescribing	N/A	1801201009	0	0	JUNG, MIN MD	4/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A146901	N/A	N/A	N/A	N/A	N/A	441 E YOSEMITE AVE	None	MADERA	CA	93638	3604	00	06000	36.96460804	-120.055598	Madera County
347294	Ordering, Referring, Prescribing	N/A	1801255484	0	0	JIMENEZ, CLARIBEL DC	1/9/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33464	N/A	N/A	N/A	N/A	N/A	1675 N PERRIS BLVD	SUITE G1	PERRIS	CA	92571	4726	00	06000	33.802137	-117.2260135	Riverside County
347296	Ordering, Referring, Prescribing	N/A	1801258140	0	0	JODESTY, YVES M JR MD	10/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158935	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
347317	Ordering, Referring, Prescribing	N/A	1801277751	0	0	JUDGE, SEAN J MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145320	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
347350	Ordering, Referring, Prescribing	N/A	1801326640	0	0	JIAN, BAO LIN MD	12/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167294	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
347357	Ordering, Referring, Prescribing	N/A	1801336433	0	0	JOHNSON, JAYME J DMD	6/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	106134	N/A	N/A	N/A	N/A	N/A	164 KINMAN AVE	None	GOLETA	CA	93117	3481	00	06000	34.436277	-119.8222815	Santa Barbara County
347493	Ordering, Referring, Prescribing	N/A	1801912209	0	0	JOHNSTON, SAMANTHA LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26273	N/A	N/A	N/A	N/A	N/A	31 TOWER ROAD	None	SAN MATEO	CA	94402	0000	00	06000	37.51232162	-122.3333429	San Mateo County
347507	Ordering, Referring, Prescribing	N/A	1801935531	0	0	JACOBSON, MARK J LCSW	7/29/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20685	N/A	N/A	N/A	N/A	N/A	2428 PROFESSIONAL DR.	SUITE 200	ROSEVILLE	CA	95661	7774	00	06000	38.74262628	-121.2416782	Placer County
347531	Ordering, Referring, Prescribing	N/A	1811000946	0	0	JOHANSEN, ANNE	9/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	18799	N/A	N/A	N/A	N/A	N/A	17215 STUDEBAKER RD	110	CERRITOS	CA	90703	2548	00	06000	33.874686	-118.0998595	Los Angeles County
347687	Ordering, Referring, Prescribing	N/A	1811298391	0	0	JUNG, CHANSUK LCSW	7/16/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76062	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	STE 9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
347688	Ordering, Referring, Prescribing	N/A	1811303555	0	0	JOHNSON, BETTY M	10/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64969	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
347727	Ordering, Referring, Prescribing	N/A	1811374549	0	0	JOHNSON, JEREMY V MD	9/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159151	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
347808	Ordering, Referring, Prescribing	N/A	1811481542	0	0	JENNINGS, MELISSA NP	9/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009380	N/A	N/A	N/A	N/A	N/A	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
347865	Ordering, Referring, Prescribing	N/A	1811602634	0	0	JOHNSON, LOIS LMFT	12/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136485	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
348052	Ordering, Referring, Prescribing	N/A	1821320656	0	0	JOHNSON, KIMBERLY S	9/11/2017	Taxonomy not applicable	NA	n/a	000	Unknown	1820	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
348152	Ordering, Referring, Prescribing	N/A	1821488115	0	0	JONES, JOSEPH D LMFT	4/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125652	N/A	N/A	N/A	N/A	N/A	2255 MYRTLE AVE	None	EUREKA	CA	95501	3387	00	06000	40.78688533	-124.132153	Humboldt County
348172	Ordering, Referring, Prescribing	N/A	1821518150	0	0	JONES, LEEANN LCSW	5/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94381	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 STE 200	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
348214	Ordering, Referring, Prescribing	N/A	1821579772	0	0	JOHNS, PAMELA J LMFT	8/30/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34187	N/A	N/A	N/A	N/A	N/A	18527 E. FRONT ST.	None	LINDEN	CA	95236	9703	00	06000	38.02135126	-121.0890147	San Joaquin County
348293	Ordering, Referring, Prescribing	N/A	1821790197	0	0	JORDAN, MARISSA MD	11/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL12580	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
348301	Ordering, Referring, Prescribing	N/A	1821874587	0	0	JANG, LISA DDS	7/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109004	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
348377	Ordering, Referring, Prescribing	N/A	1831316892	0	0	JACKSON, JACOB MD	2/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105277	N/A	N/A	N/A	N/A	N/A	2400 GLENDALE LN	None	SACRAMENTO	CA	95825	2431	00	06000	38.597355	-121.405212	Sacramento County
348382	Ordering, Referring, Prescribing	N/A	1831322999	0	0	JOLLY, LAUREN M LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW63281	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
348551	Ordering, Referring, Prescribing	N/A	1831632967	0	0	JIMENEZ-PUENTE, SARAH A LCSW	11/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98671	N/A	N/A	N/A	N/A	N/A	17801 INDUSTRIAL FARM RD	None	BAKERSFIELD	CA	93308	9599	00	06000	35.507466	-119.112165	Kern County
348566	Ordering, Referring, Prescribing	N/A	1831652254	0	0	JORGENSEN, JENNA C MD	3/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176988	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
348614	Ordering, Referring, Prescribing	N/A	1831704907	0	0	JOE, DEREK PHARMD	2/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81593	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
348632	Ordering, Referring, Prescribing	N/A	1831745074	0	0	JIMENEZ, IVIANA LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116571	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
348741	Ordering, Referring, Prescribing	N/A	1841312972	0	0	JALALI, FARANGIS MD	2/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A91998	N/A	N/A	N/A	N/A	N/A	362 THIRD STREET	None	LAGUNA BEACH	CA	92651	2307	00	06000	33.54392197	-117.780894	Orange County
348801	Ordering, Referring, Prescribing	N/A	1841416559	0	0	JOINER, THOMAS D LCSW	7/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17991	N/A	N/A	N/A	N/A	N/A	3123 INDEPENDENCE DR.	None	LIVERMORE	CA	94550	3847	00	06000	37.70689639	-121.8138979	Alameda County
348811	Ordering, Referring, Prescribing	N/A	1841439239	0	0	JAMSHIDIAN, FARZAD MD	12/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168604	N/A	N/A	N/A	N/A	N/A	75036 GERALD FORD DR	None	PALM DESERT	CA	92211	2080	00	06000	33.78158473	-116.353994	Riverside County
348842	Ordering, Referring, Prescribing	N/A	1841488723	0	0	JENKINS, WILLIAM D LMFT	5/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	16368	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
348935	Ordering, Referring, Prescribing	N/A	1841634185	0	0	JOHN, LIJU S MD	5/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C186512	N/A	N/A	N/A	N/A	N/A	1120 W AVENUE M4	None	PALMDALE	CA	93551	1432	00	06000	34.64264888	-118.1509125	Los Angeles County
349004	Ordering, Referring, Prescribing	N/A	1841739497	0	0	JUAREZ ARTEAGA, ADRIANA MARIA LMFT	10/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128446	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVENUE	100	SOUTH SAN FRANCIS	CA	94080	5971	00	06000	37.64441633	-122.4219331	San Mateo County
349278	Ordering, Referring, Prescribing	N/A	1851610661	0	0	JARVIS, TERESA A CNM	10/14/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236029	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
349288	Ordering, Referring, Prescribing	N/A	1851636880	0	0	JAEGER, CATHERINE D LMFT	8/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90936	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
349298	Ordering, Referring, Prescribing	N/A	1851649602	0	0	JAUREGUI ORNELAS, CECILIA LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76791	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	1ST FLOOR	SAN PABLO	CA	94803	0000	00	06000	37.95651393	-122.3371491	Contra Costa County
349352	Ordering, Referring, Prescribing	N/A	1851726897	0	0	JOYNER, KRISTEN PSYD	8/23/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27764	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
349370	Ordering, Referring, Prescribing	N/A	1851748206	0	0	JAMES, REBECCA L CCC-SLP	6/17/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP14137	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
349427	Ordering, Referring, Prescribing	N/A	1851823645	0	0	JAYME, ANA JASMINE L LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116890	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	3RD FL	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
349455	Ordering, Referring, Prescribing	N/A	1851874457	0	0	JORY, KENDALL LMFT	3/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132008	N/A	N/A	N/A	N/A	N/A	948 EMBARCADERO DEL NORT	STE 102	GOLETA	CA	93117	5106	00	06000	34.412031	-119.855363	Santa Barbara County
349466	Ordering, Referring, Prescribing	N/A	1851877930	0	0	JACOBSON, BRIAN J PA	10/4/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57284	N/A	N/A	N/A	N/A	N/A	71777 SAN JANCINTO DRIVE	SUITE 202	RANCHO MIRAGE	CA	92270	0000	00	06000	33.74394755	-116.4124572	Riverside County
349568	Ordering, Referring, Prescribing	N/A	1861124950	0	0	JAMES, ELYSE LCSW	3/13/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121241	N/A	N/A	N/A	N/A	N/A	325 BUENA CREEK RD	None	SAN MARCOS	CA	92069	9679	00	06000	33.18307285	-117.160072	San Diego County
349610	Ordering, Referring, Prescribing	N/A	1861514432	0	0	JACOBS, JULIE L DDS	2/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55110	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
349630	Ordering, Referring, Prescribing	N/A	1861549032	0	0	JONES, LOIDA L LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49758	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE, SUITE 2	None	CONCORD	CA	94520	4886	00	06000	37.98393807	-122.0466953	Contra Costa County
349634	Ordering, Referring, Prescribing	N/A	1861542912	0	0	JONES, KIMBERLY A LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40418	N/A	N/A	N/A	N/A	N/A	300 EAST LELAND RD	# 100	PITTSBURG	CA	94596	4960	00	06000	38.01129897	-121.8878132	Contra Costa County
349673	Ordering, Referring, Prescribing	N/A	1861646333	0	0	JENG, YU-CHEN J	6/25/2012	Taxonomy not applicable	NA	n/a	099	DENTIST	D52872	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
349683	Ordering, Referring, Prescribing	N/A	1861680167	0	0	JETER, LINDA LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105090	N/A	N/A	N/A	N/A	N/A	3517 CAMINO DEL RIO S	STE 407	SAN DIEGO	CA	92108	4026	00	06000	32.77777042	-117.1179225	San Diego County
349703	Ordering, Referring, Prescribing	N/A	1861722886	0	0	JONES, BENNY R	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76771	N/A	N/A	N/A	N/A	N/A	550 N VENTU PARK RD	None	NEWBURY PARK	CA	91320	2709	00	06000	34.18715094	-118.911061	Ventura County
349875	Ordering, Referring, Prescribing	N/A	1861987570	0	0	JENO, MARY MD	5/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186019	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
349899	Ordering, Referring, Prescribing	N/A	1871019075	0	0	JACOBUS, LOUIS R LMFT	9/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134999	N/A	N/A	N/A	N/A	N/A	1200 CONCORD AVE	SUITE 450	CONCORD	CA	94520	4959	00	06000	37.98072455	-122.0545603	Contra Costa County
349951	Ordering, Referring, Prescribing	N/A	1871084715	0	0	JEANNETHE, CARDOZA C	5/17/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82778	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
350085	Ordering, Referring, Prescribing	N/A	1871627497	0	0	JUGANT MCGREGOR, ANNIQUE MD	7/3/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61099	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
350101	Ordering, Referring, Prescribing	N/A	1871651083	0	0	JOHNSTON, CARMELLA R LMFT	8/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99482	N/A	N/A	N/A	N/A	N/A	1936 CARLOTTA DR	None	CONCORD	CA	94519	1358	00	06000	37.98614491	-122.0061167	Contra Costa County
350146	Ordering, Referring, Prescribing	N/A	1871751206	0	0	JONES, RANDOLPH MD	10/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C38951	N/A	N/A	N/A	N/A	N/A	1530 EAST EDINGER	None	SANTA ANA	CA	92705	5119	00	06000	33.72667401	-117.84896	Orange County
350158	Ordering, Referring, Prescribing	N/A	1871772020	0	0	JASSO, MARTHA LCSW	1/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26493	N/A	N/A	N/A	N/A	N/A	4167 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1642	00	06000	32.75259154	-117.1008418	San Diego County
350176	Ordering, Referring, Prescribing	N/A	1871803924	0	0	JONES, ERIC PHARMD	7/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64354	N/A	N/A	N/A	N/A	N/A	2516 SHADOW MOUNTAIN CT	None	SAN RAMON	CA	94583	1823	00	06000	37.77264267	-121.9809968	Contra Costa County
350235	Ordering, Referring, Prescribing	N/A	1871893230	0	0	JONES, SERENA A LCSW	9/19/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15214	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
350276	Ordering, Referring, Prescribing	N/A	1871942862	0	0	JONES, TIFFANY M LCSW	12/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119945	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
350382	Ordering, Referring, Prescribing	N/A	1881086585	0	0	JACKSON, JANINE LCSW	2/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82951	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
350428	Ordering, Referring, Prescribing	N/A	1881161388	0	0	JULIAN, JEAZALE CNP	6/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008813	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
350518	Ordering, Referring, Prescribing	N/A	1881378792	0	0	JALUDI, SUMAYA PHARMD	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87853	N/A	N/A	N/A	N/A	N/A	1790 DECOTO RD	None	FREMONT	CA	94587	3524	00	06000	37.58826644	-122.021143	Alameda County
350559	Ordering, Referring, Prescribing	N/A	1881719177	0	0	JOSEPH, KARRERA LMFT	5/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146726	N/A	N/A	N/A	N/A	N/A	5054 S VERMONT AVE	None	LOS ANGELES	CA	90037	2946	00	06000	33.996681	-118.291502	Los Angeles County
350589	Ordering, Referring, Prescribing	N/A	1881760114	0	0	JAUL, DOUGLAS H	7/1/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D30075	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
350616	Ordering, Referring, Prescribing	N/A	1881830859	0	0	JAIME, LISA A PA	12/4/2017	Taxonomy not applicable	NA	n/a	000	Unknown	20112	N/A	N/A	N/A	N/A	N/A	31180 ROAD 72	None	GOSHEN	CA	93227	9997	00	06000	36.35594779	-119.4124242	Tulare County
350674	Ordering, Referring, Prescribing	N/A	1881949972	0	0	JONES, DORIS LMFT	6/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126318	N/A	N/A	N/A	N/A	N/A	768 PLEASANT VALLEY RD	None	DIAMOND SPRINGS	CA	95619	9260	00	06000	38.69498433	-120.8070771	El Dorado County
350701	Ordering, Referring, Prescribing	N/A	1881994945	0	0	JONES, RICHARD N PHARMD	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44496	N/A	N/A	N/A	N/A	N/A	250 E PARKERCENTER BLVD.	None	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
350717	Ordering, Referring, Prescribing	N/A	1891034450	0	0	JAMES, ALONDRA LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27481	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
350837	Ordering, Referring, Prescribing	N/A	1891212098	0	0	JEON, EUNICE J	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101615	N/A	N/A	N/A	N/A	N/A	8616 LA TIJERA BLVD	200	LOS ANGELES	CA	90045	3944	00	06000	33.95943215	-118.3918599	Los Angeles County
350840	Ordering, Referring, Prescribing	N/A	1891223897	0	0	JOHANSEN, PAMELA S LCSW	3/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW14640	N/A	N/A	N/A	N/A	N/A	7 GILLICK WAY	None	OROVILLE	CA	95965	3595	00	06000	39.529494	-121.574151	Butte County
350887	Ordering, Referring, Prescribing	N/A	1891307138	0	0	JOO, ANTHONY SUNG JIN PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82387	N/A	N/A	N/A	N/A	N/A	37160 47TH ST E	None	PALMDALE	CA	93552	4450	00	06000	34.557426	-118.0452945	Los Angeles County
350932	Ordering, Referring, Prescribing	N/A	1891428496	0	0	JAMISON, ROSEMARY LCSW	2/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107064	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
351017	Ordering, Referring, Prescribing	N/A	1891852133	0	0	JOHNSON, JESSICA B LMFT	8/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47746	N/A	N/A	N/A	N/A	N/A	2351 OLIVERA RD	None	CONCORD	CA	94520	1626	00	06000	37.99636083	-122.0356799	Contra Costa County
351045	Ordering, Referring, Prescribing	N/A	1891941324	0	0	JEW, KENNETH F OD	10/12/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13513	N/A	N/A	N/A	N/A	N/A	386 GELLERT BLVD	B, C, D	DALY CITY	CA	94015	2611	00	06000	37.66532592	-122.4690476	San Mateo County
351051	Ordering, Referring, Prescribing	N/A	1891936332	0	0	JARA, LIDIA LCSW	11/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98586	N/A	N/A	N/A	N/A	N/A	2500 S C ST	None	OXNARD	CA	93033	4560	00	06000	34.17646093	-119.1812737	Ventura County
351101	Ordering, Referring, Prescribing	N/A	1902054711	0	0	JOHNSON, PAMELA LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68544	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
351125	Ordering, Referring, Prescribing	N/A	1902093438	0	0	JOHNSON, KELLY N LCSW	1/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29904	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
351131	Ordering, Referring, Prescribing	N/A	1902106388	0	0	JENNINGS, KATHERINE A	4/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50049	N/A	N/A	N/A	N/A	N/A	13255 BLACK MOUNTAIN RD	None	SAN DIEGO	CA	92129	2658	00	06000	32.95881607	-117.1266381	San Diego County
351155	Ordering, Referring, Prescribing	N/A	1902155625	0	0	JONNEY, JORLY T LCSW	1/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108237	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
351164	Ordering, Referring, Prescribing	N/A	1902166275	0	0	JONES, CASSANDRA LMFT	10/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88241	N/A	N/A	N/A	N/A	N/A	233 W. BASELINE RD.	None	LA VERNE	CA	91750	1864	00	06000	34.12068064	-117.7523547	Los Angeles County
351194	Ordering, Referring, Prescribing	N/A	1902206741	0	0	JOHNSON, AUTUMN LCSW	9/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82372	N/A	N/A	N/A	N/A	N/A	1026B GEARALD WAY	None	FALLBROOK	CA	92028	3564	00	06000	33.37298241	-117.2376429	San Diego County
351288	Ordering, Referring, Prescribing	N/A	1902353964	0	0	JOSEPH, JESHURUN LCSW	1/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95680	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
351295	Ordering, Referring, Prescribing	N/A	1902380884	0	0	JACOT, SAMANTHA NP	12/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009921	N/A	N/A	N/A	N/A	N/A	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.27804785	-120.649711	San Luis Obispo County
351371	Ordering, Referring, Prescribing	N/A	1902836190	0	0	JAYARATNA, MAHINDA A MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42511	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	100	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
351405	Ordering, Referring, Prescribing	N/A	1902932700	0	0	JAMES, JEAN I NP	11/18/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8073	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
351439	Ordering, Referring, Prescribing	N/A	1902954126	0	0	JASKOSKI, DAVID J LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36357	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DRIVE	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
351466	Ordering, Referring, Prescribing	N/A	1902995277	0	0	JANTZ, JULIE A	2/7/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0444195	N/A	N/A	N/A	N/A	N/A	11722 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
351506	Ordering, Referring, Prescribing	N/A	1912124124	0	0	JONES, JOE F LMFT	7/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120405	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
351524	Ordering, Referring, Prescribing	N/A	1912158700	0	0	JONES, MATILDE G LMFT	10/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88833	N/A	N/A	N/A	N/A	N/A	2719 N AIR FRESNO DR	None	FRESNO	CA	93727	1546	00	06000	36.77448139	-119.7281325	Fresno County
351537	Ordering, Referring, Prescribing	N/A	1912198409	0	0	JONES, PAMELA J MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83514	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
351564	Ordering, Referring, Prescribing	N/A	1912243221	0	0	JOHNSON, DARRIN LCSW	8/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91259	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
351579	Ordering, Referring, Prescribing	N/A	1912274622	0	0	JON-UBABUCO, NNEKA C	4/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95011559	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
351637	Ordering, Referring, Prescribing	N/A	1912347642	0	0	JUAREZ SUSSAN, CYNTHIA P LCSW	2/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87583	N/A	N/A	N/A	N/A	N/A	6651 BALBOA BLVD	None	VAN NUYS	CA	91406	5529	00	06000	34.191468	-118.5011883	Los Angeles County
351671	Ordering, Referring, Prescribing	N/A	1912388505	0	0	JASON, DEBORA S PHD	3/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28623	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
351680	Ordering, Referring, Prescribing	N/A	1912403460	0	0	JUNG, JAMES MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164394	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	00	06000	38.555181	-121.4566785	Sacramento County
351726	Ordering, Referring, Prescribing	N/A	1912471566	0	0	JANG, JIHO PHARMD	11/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80032	N/A	N/A	N/A	N/A	N/A	1071 11TH ST	None	LAKEPORT	CA	95453	4105	00	06000	39.04902974	-122.9257209	Lake County
351730	Ordering, Referring, Prescribing	N/A	1912475013	0	0	JAVANBAKHSH, PARISA	6/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139977	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
351840	Ordering, Referring, Prescribing	N/A	1912985888	0	0	JAWANDHA, ARSHDEEP MD	4/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107401	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
351864	Ordering, Referring, Prescribing	N/A	1922096932	0	0	JOHNS, JEFFREY F MD	12/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93824	N/A	N/A	N/A	N/A	N/A	2640 MARTIN LUTHER KING	None	BERKELEY	CA	94704	3238	00	06000	37.85995514	-122.2717612	Alameda County
351903	Ordering, Referring, Prescribing	N/A	1922203157	0	0	JORDAN-MANZANO, CARLOS MD	2/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106140	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
351981	Ordering, Referring, Prescribing	N/A	1922375971	0	0	JOHNSON, LEIGH	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53504	N/A	N/A	N/A	N/A	N/A	770 1ST STREET	None	GILROY	CA	95020	4972	00	06000	37.01344257	-121.5843817	Santa Clara County
352000	Ordering, Referring, Prescribing	N/A	1922402700	0	0	JACOBSON, CATHLEEN C LMFT	12/4/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41701	N/A	N/A	N/A	N/A	N/A	3107 S GRAND AVE	None	LOS ANGELES	CA	90007	3816	00	06000	34.02221271	-118.2750172	Los Angeles County
352111	Ordering, Referring, Prescribing	N/A	1922555028	0	0	JONES, KIMBERLY OT	1/27/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT19806	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
352172	Ordering, Referring, Prescribing	N/A	1922699438	0	0	JACOBS, CHARMAINE C LMFT	9/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123172	N/A	N/A	N/A	N/A	N/A	5266 HOLLISTER AVE	SUITE 101	SANTA BARBARA	CA	93111	2066	00	06000	34.43497016	-119.8071895	Santa Barbara County
352181	Ordering, Referring, Prescribing	N/A	1922710169	0	0	JOHNSON, LASHELLE S NP	6/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021289	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
352274	Ordering, Referring, Prescribing	N/A	1932277357	0	0	JARASITIS, GREGORY A OT	6/4/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	5733	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
352298	Ordering, Referring, Prescribing	N/A	1932352978	0	0	JOSON, JEREMIAH L PHARMD	4/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	54965	N/A	N/A	N/A	N/A	N/A	KERN MEDICAL	1700 MT. VERNON AVE.	BAKERSFIELD	CA	93306	4018	00	06000	0	0	None
352311	Ordering, Referring, Prescribing	N/A	1932396793	0	0	JIMENEZ, INGRID M LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77368	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
352317	Ordering, Referring, Prescribing	N/A	1932410750	0	0	JABRI, LAMIS MD	10/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154355	N/A	N/A	N/A	N/A	N/A	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	00	06000	33.850449	-118.1848215	Los Angeles County
352540	Ordering, Referring, Prescribing	N/A	1932754603	0	0	JIMENEZ, KATRINA M LMFT	7/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133774	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
352570	Ordering, Referring, Prescribing	N/A	1932835782	0	0	JUNG, MARY E PA-C	6/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64679	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
352591	Ordering, Referring, Prescribing	N/A	1932940400	0	0	JAHANGIR, SAIRAH B LCSW	4/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121853	N/A	N/A	N/A	N/A	N/A	1695 S SAN JACINTO	SUITE A	SAN JACINTO	CA	92583	5103	00	06000	33.770961	-116.954649	Riverside County
352603	Ordering, Referring, Prescribing	N/A	1942204961	0	0	JOURDAN FIGUEROA, LUIS A MD	10/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	0420013627	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE.	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
352614	Ordering, Referring, Prescribing	N/A	1942274261	0	0	JAMES, TAMMI MD	3/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84974	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
352691	Ordering, Referring, Prescribing	N/A	1942454673	0	0	JAMAH, HANI DDS	10/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	CA57558	N/A	N/A	N/A	N/A	N/A	4737 SONOMA HWY	B	SANTA ROSA	CA	95409	4267	00	06000	38.46295668	-122.6681992	Sonoma County
352779	Ordering, Referring, Prescribing	N/A	1942628128	0	0	JAIN, MEGHAN MD	4/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138547	N/A	N/A	N/A	N/A	N/A	651 WAKE AVE	None	EL CENTRO	CA	92243	9490	00	06000	32.7706161	-115.5585732	Imperial County
352837	Ordering, Referring, Prescribing	N/A	1942703293	0	0	JORGENSEN, BLAKE LMFT	6/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119308	N/A	N/A	N/A	N/A	N/A	1 ST. VINCENT''S DR.	None	SAN RAFAEL	CA	94903	1504	00	06000	38.034216	-122.525199	Marin County
352857	Ordering, Referring, Prescribing	N/A	1942736129	0	0	JIMMEYE, CYNTHIA C NP	6/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	796198	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
352900	Ordering, Referring, Prescribing	N/A	1942810098	0	0	JUNG, MEAGHAN L	10/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95202205	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
352904	Ordering, Referring, Prescribing	N/A	1942815550	0	0	JONES, ALYCIA S LCSW	3/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94372	N/A	N/A	N/A	N/A	N/A	9925 INTERNATIONAL BLVD	5	OAKLAND	CA	94603	2558	00	06000	37.74332565	-122.1698542	Alameda County
352925	Ordering, Referring, Prescribing	N/A	1942860937	0	0	JESSON, JENIFER E	9/23/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104055	N/A	N/A	N/A	N/A	N/A	1111 N NAGLE ST	None	ALTURAS	CA	96101	3840	00	06000	41.48746641	-120.5528507	Modoc County
352955	Ordering, Referring, Prescribing	N/A	1942943840	0	0	JONES, HALEY M	4/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3973	N/A	N/A	N/A	N/A	N/A	624 HARRIS ST	None	EUREKA	CA	95503	4448	00	06000	40.7803262	-124.1621816	Humboldt County
353086	Ordering, Referring, Prescribing	N/A	1952543746	0	0	JOSLIN, MELISSA A LCSW	9/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74307	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	C2	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
353093	Ordering, Referring, Prescribing	N/A	1952558181	0	0	JONES, JENNIFER J LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97584	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
353132	Ordering, Referring, Prescribing	N/A	1952641805	0	0	JACKSON, NATASHA LMSW	1/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120188	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0518	00	06000	39.03521526	-120.9755343	Placer County
353200	Ordering, Referring, Prescribing	N/A	1952747685	0	0	JANOWITCH, LAURA PSYD	3/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28044	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST.	259	OAKLAND	CA	19527	4768	00	06000	37.77617499	-122.2247899	Alameda County
353229	Ordering, Referring, Prescribing	N/A	1952792335	0	0	JOHNSON, NATALIE A PA-C	7/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA52277	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
353291	Ordering, Referring, Prescribing	N/A	1952884124	0	0	JALAO, LY KONG PHENG NP	8/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009751	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
353313	Ordering, Referring, Prescribing	N/A	1952946956	0	0	JOSEPH BAPTISTE PORTER, AMELLE NP	11/12/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013219	N/A	N/A	N/A	N/A	N/A	3638 DELMAS TER	None	CULVER CITY	CA	90232	3300	00	06000	34.0230143	-118.3971859	Los Angeles County
353371	Ordering, Referring, Prescribing	N/A	1962057281	0	0	JASPER, KYLE D NP	10/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015599	N/A	N/A	N/A	N/A	N/A	1103 N B STREET	SUITE E	SACRAMENTO	CA	95811	0326	00	06000	38.59119	-121.48659	Sacramento County
353402	Ordering, Referring, Prescribing	N/A	1962163022	0	0	JACKSON, KAVONNA M NP	10/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018820	N/A	N/A	N/A	N/A	N/A	23520 CACTUS AVE	None	MORENO VALLEY	CA	92553	8906	00	06000	33.91028375	-117.2519375	Riverside County
353418	Ordering, Referring, Prescribing	N/A	1962227686	0	0	JOHNSON, EMILY L NP	10/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032512	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0000	00	06000	33.71470753	-117.8323965	Orange County
353429	Ordering, Referring, Prescribing	N/A	1962279372	0	0	JAVAHERNESHAN, ARYANA I PA	2/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64058	N/A	N/A	N/A	N/A	N/A	1873 COMMERCENTER WEST	None	SAN BERNARDINO	CA	92408	3303	00	06000	34.067781	-117.286122	San Bernardino County
353471	Ordering, Referring, Prescribing	N/A	1962564450	0	0	JOHNSON, STEPHANIE PSYD	6/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23722	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
353484	Ordering, Referring, Prescribing	N/A	1962587238	0	0	JUE, MAY A PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49619	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPWY	DEPT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
353503	Ordering, Referring, Prescribing	N/A	1962625756	0	0	JAMES, EVELYN A NMP	2/26/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0666862	N/A	N/A	N/A	N/A	N/A	1833 FILLMORE ST	FL 3	SAN FRANCISCO	CA	94115	3181	00	06000	37.78652252	-122.4333821	San Francisco County
353554	Ordering, Referring, Prescribing	N/A	1962722934	0	0	JONES, GAYANA V LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92530	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
353601	Ordering, Referring, Prescribing	N/A	1962785410	0	0	JENSEN-BEST, SHANNON R LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109881	N/A	N/A	N/A	N/A	N/A	1989 VICENTE DR	A	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
353630	Ordering, Referring, Prescribing	N/A	1962824391	0	0	JAN, MAGGIE OD FAAO	10/21/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14641	N/A	N/A	N/A	N/A	N/A	5460 E LA PALMA AVE	None	ANAHEIM	CA	92807	2023	00	06000	33.85983003	-117.7966383	Orange County
353765	Ordering, Referring, Prescribing	N/A	1972028439	0	0	JOHNSON, JANELLE K LMFT	7/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT133555	N/A	N/A	N/A	N/A	N/A	820 34TH ST	100	BAKERSFIELD	CA	93301	2283	00	06000	35.39053308	-119.0117133	Kern County
353767	Ordering, Referring, Prescribing	N/A	1972036879	0	0	JAYAKUMAR, PRIYANGA MD	12/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166928	N/A	N/A	N/A	N/A	N/A	7060 N RECREATION AVE	None	FRESNO	CA	93720	8022	00	06000	36.8388	-119.7404335	Fresno County
353975	Ordering, Referring, Prescribing	N/A	1972723104	0	0	JUDKINS, JEREMIAH W	2/27/2019	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	44395	N/A	N/A	N/A	N/A	N/A	355 NEW SHACKLE ISLAND R	None	HENDERSONVILLE	TN	37075	0000	00	06000	36.324738	-86.6229075	Sumner County
354039	Ordering, Referring, Prescribing	N/A	1972856508	0	0	JEN, CHIAI LMFT	10/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105582	N/A	N/A	N/A	N/A	N/A	211 EASTMOOR AVE	None	DALY CITY	CA	94015	2036	00	06000	37.6847337	-122.4787562	San Mateo County
354054	Ordering, Referring, Prescribing	N/A	1972883882	0	0	JU, NATHANIEL DC	12/10/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC32054	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
354161	Ordering, Referring, Prescribing	N/A	1982021978	0	0	JIMENEZ MATA, KARLA I LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117980	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
354202	Ordering, Referring, Prescribing	N/A	1982079836	0	0	JENVAY, SEAN MD	6/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182174	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
354209	Ordering, Referring, Prescribing	N/A	1982100665	0	0	JENNER, ZACHARY B	3/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165863	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
354392	Ordering, Referring, Prescribing	N/A	1982735023	0	0	JAFFE, AMY R LCSW	10/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW13977	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
354401	Ordering, Referring, Prescribing	N/A	1982744116	0	0	JAMES, MIAISHA I LMFT	6/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139852	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
354438	Ordering, Referring, Prescribing	N/A	1982829248	0	0	JUAREZ, THADDEUS M	12/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83085	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
354454	Ordering, Referring, Prescribing	N/A	1982860037	0	0	JUNG, SONJA L	3/12/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0607446	N/A	N/A	N/A	N/A	N/A	1833 FILLMORE ST	None	SAN FRANCISCO	CA	94115	3179	00	06000	37.78652252	-122.4333821	San Francisco County
354484	Ordering, Referring, Prescribing	N/A	1982924965	0	0	JOHNSTON, BARBARA L	10/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23996	N/A	N/A	N/A	N/A	N/A	201 N CIVIC DR	183	WALNUT CREEK	CA	94596	3864	00	06000	37.91024298	-122.0593495	Contra Costa County
354502	Ordering, Referring, Prescribing	N/A	1982963435	0	0	JUAREZ, GRACE M DO MD	2/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123110	N/A	N/A	N/A	N/A	N/A	100 OAK STREET	F-3	SAN JOSE	CA	95110	2817	00	06000	37.3216329	-121.8819037	Santa Clara County
354509	Ordering, Referring, Prescribing	N/A	1982972014	0	0	JUNG, HORACE G PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	33379	N/A	N/A	N/A	N/A	N/A	965 GENEVA AVE	None	SAN FRANCISCO	CA	94112	3423	00	06000	37.71584494	-122.4397176	San Francisco County
354588	Ordering, Referring, Prescribing	N/A	1992090278	0	0	JONES, JALECIA K LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88356	N/A	N/A	N/A	N/A	N/A	1500 DERBY ST	None	BERKELEY	CA	94703	1817	00	06000	37.85882742	-122.2790533	Alameda County
354599	Ordering, Referring, Prescribing	N/A	1992103220	0	0	JONES, RYAN A MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166885	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
354636	Ordering, Referring, Prescribing	N/A	1992155782	0	0	JAMISON, NATHAN K MD	6/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168935	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
354889	Ordering, Referring, Prescribing	N/A	1992917926	0	0	JOB, ALLEN J	9/16/2005	Taxonomy not applicable	NA	n/a	099	DENTIST	D51265	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